Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions

Abstract

A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incision with layered closure (n = 137), a midline incision with mass closure (n = 104) or a midline incision using layered closure (n = 108), endeavouring to close the latter two incisions with a measured suture length to wound length ratio of greater than 4:1. After 18 months follow-up, no patient in the lateral paramedian group had developed an incisional hernia whereas 7 of 104 patients undergoing a midline incision with mass closure and 7 of 108 patients undergoing a midline incision with layered closure had incisional hernias (P less than 0.01). The mean suture length to wound length ratios for the three groups were 2.6 (range 1.3-6.2), 5.0 (range 3.0-8.7) and 3.7 (range 2.0-6.3) respectively (P less than 0.0001). The lateral paramedian incision remains superior to the midline incision closed with the mass technique and its integrity is independent of the suture length to wound length ratio.

Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

“…It is comparable with studies conducted by Ellis H et al and Khan NA et al and Murtaza B et al 11 Incidence of burst abdomen for layered closure group is 3.3%, which is comparable with other studies. 2,5 The incidence of incisional hernia for mass closure is 6.6% in present study; it is comparable with other studies. 2,5,8,12 The incidence of incisional hernia in layered closure group is 6.6%, and is higher as compared to other studies this may be due to small sample size in present study.…”

“…2,5 The incidence of incisional hernia for mass closure is 6.6% in present study; it is comparable with other studies. 2,5,8,12 The incidence of incisional hernia in layered closure group is 6.6%, and is higher as compared to other studies this may be due to small sample size in present study. 2,5 In present study, the incidence of suture sinus formation for mass closure group is 0%.…”

“…[4][5][6] As compared to studies by Leaper DJ et al and Khan NA et al it is less and this may be because of small sample size in present study. 7,8 In the study conducted by Israelsson et al and Bloemen et al the incidence of wound infection is 9.4% and 7.7% respectively in mass closure group.…”

“…2,5,8,12 The incidence of incisional hernia in layered closure group is 6.6%, and is higher as compared to other studies this may be due to small sample size in present study. 2,5 In present study, the incidence of suture sinus formation for mass closure group is 0%. Similar findings were reported in the studies conducted by krukowski et al and Brolin et al whereas incidence of suture sinus formation in layered closure group in present study is 3.33% which is comparable with Wissing et al study.…”

“…This figure is comparable with Kendal et al study. 5 Mean closure time for layered closure group in present study is 21.2 min and in Kendal et al study it is 18 min. The time required in layered closure group in present study is slightly higher and this may due to personal variation as all the faculty members were involved in the treatment of patient.…”