Journal Article

The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations

Zielska, Z., Baumann, P., Golling, M., Breul, V.

2024

Overview

Aim To analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. Method Prospective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries. Results We included 351 patients (♂: 208; ♀: 143) with midline ( n  = 194), transverse ( n  = 103), and a combined midline/transverse L-shaped ( n  = 54) incisions. There was no quality difference in short stitches between elective ( n  = 296) and emergency ( n  = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p  < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p  < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time. Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)—twice as common in emergency than elective surgery (12,7 vs 5,1%)—necessitating an abdominal revision in 86,3% of cases. Conclusion We could show that a short stitch 6:1 SL/WL-ratio with a 2–0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision. Clinical Trials.gov Identifier NCT01938222.

• Publisher: Springer Paris,Springer Nature B.V
• Subject: Abdomen / Abdominal Muscles - surgery / Abdominal Surgery / Abdominal wall / Abdominal Wall - surgery / Abdominal Wound Closure Techniques / Clinical trials / Cohort Studies / Dehiscence / Female / Herniorrhaphy / Humans / Laparotomy / Laparotomy - adverse effects / Laparotomy - methods / Male / Medicine / Medicine & Public Health / Original / Original Article / Patients / Prospective Studies / Surgery / Surgical site infections / Suture Techniques / Sutures / Wound healing / γ-Hydroxybutyric acid