Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial
Abstract Background Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material. Methods A prospective, multicentre, parallel-group, double-blind, randomized, controlled...
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| Veröffentlicht in: | British journal of surgery 2022-08, Vol.109 (9), p.839-845 |
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| creator | Fortelny, René H Andrade, Dorian Schirren, Malte Baumann, Petra Riedl, Stefan Reisensohn, Claudia Kewer, Jan Ludolf Hoelderle, Jessica Shamiyeh, Andreas Klugsberger, Bettina Maier, Theo David Schumacher, Guido Köckerling, Ferdinand Pession, Ursula Hofmann, Anna Albertsmeier, Markus |
| description | Abstract
Background
Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.
Methods
A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome.
Results
The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P |
| doi_str_mv | 10.1093/bjs/znac194 |
| format | Article |
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Background
Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.
Methods
A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome.
Results
The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173).
Conclusion
The 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches.
Registration number: NCT01965249 (http://www.clinicaltrials.gov)
This randomized clinical trial revealed no statistically significant difference in incisional hernia rate 1 year after laparotomy closure with short or long stitches. We found low hernia rates in both groups of this trial using an ultra-long-term absorbent elastic suture material.</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1093/bjs/znac194</identifier><identifier>PMID: 35707932</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Abdominal Wound Closure Techniques ; Adult ; Editor's Choice ; Humans ; Incisional Hernia - surgery ; Laparotomy - methods ; Prospective Studies ; Randomized Clinical Trial ; Suture Techniques ; Sutures</subject><ispartof>British journal of surgery, 2022-08, Vol.109 (9), p.839-845</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-dd5a8bd040a7e78cd45f697e4355dc5232a7dbbec6202e0111f1d0fba779e9653</citedby><orcidid>0000-0002-5830-3536 ; 0000-0002-5028-5062</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35707932$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fortelny, René H</creatorcontrib><creatorcontrib>Andrade, Dorian</creatorcontrib><creatorcontrib>Schirren, Malte</creatorcontrib><creatorcontrib>Baumann, Petra</creatorcontrib><creatorcontrib>Riedl, Stefan</creatorcontrib><creatorcontrib>Reisensohn, Claudia</creatorcontrib><creatorcontrib>Kewer, Jan Ludolf</creatorcontrib><creatorcontrib>Hoelderle, Jessica</creatorcontrib><creatorcontrib>Shamiyeh, Andreas</creatorcontrib><creatorcontrib>Klugsberger, Bettina</creatorcontrib><creatorcontrib>Maier, Theo David</creatorcontrib><creatorcontrib>Schumacher, Guido</creatorcontrib><creatorcontrib>Köckerling, Ferdinand</creatorcontrib><creatorcontrib>Pession, Ursula</creatorcontrib><creatorcontrib>Hofmann, Anna</creatorcontrib><creatorcontrib>Albertsmeier, Markus</creatorcontrib><title>Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Abstract
Background
Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.
Methods
A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome.
Results
The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173).
Conclusion
The 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches.
Registration number: NCT01965249 (http://www.clinicaltrials.gov)
This randomized clinical trial revealed no statistically significant difference in incisional hernia rate 1 year after laparotomy closure with short or long stitches. We found low hernia rates in both groups of this trial using an ultra-long-term absorbent elastic suture material.</description><subject>Abdominal Wound Closure Techniques</subject><subject>Adult</subject><subject>Editor's Choice</subject><subject>Humans</subject><subject>Incisional Hernia - surgery</subject><subject>Laparotomy - methods</subject><subject>Prospective Studies</subject><subject>Randomized Clinical Trial</subject><subject>Suture Techniques</subject><subject>Sutures</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNpVUU1LHDEYDlLprmtP3ktORQ-j-ZhMdryUIlsVBA-u55BJ3ulkmUnWJFOo9Md3lt2Knl54ny94HoTOKLmkpOZXzSZdvXptaF0eoTnllSgYrZaf0JwQIgvKGZ-hk5Q2hFBOBPuMZlxIImvO5ujvqm3B5IRDi3MHOHUhZpyyy6bDGUzn3csIuA0RD872zgPWjQ2D87rHpg9pjICDx84bl1zYfTuI3ml8vnpaP97fXVzjqP1O8Qp2UjjvzETK0en-FB23uk_w5XAX6Pnnan1zVzw83t7f_HgoDJcyF9YKvWwsKYmWIJfGlqKtagklF8IawTjT0jYNmIoRBoRS2lJL2kZLWUNdCb5A3_e-27EZwBrwOepebaMbdPyjgnbqI-Jdp36F34oSXpWSLyeH84NDDFMfKavBJQN9rz2EMSlWSSlkWU97LNDX92FvKf87nwjf9oQwbt9QStRuTDWNqQ5j8n-mepOI</recordid><startdate>20220816</startdate><enddate>20220816</enddate><creator>Fortelny, René H</creator><creator>Andrade, Dorian</creator><creator>Schirren, Malte</creator><creator>Baumann, Petra</creator><creator>Riedl, Stefan</creator><creator>Reisensohn, Claudia</creator><creator>Kewer, Jan Ludolf</creator><creator>Hoelderle, Jessica</creator><creator>Shamiyeh, Andreas</creator><creator>Klugsberger, Bettina</creator><creator>Maier, Theo David</creator><creator>Schumacher, Guido</creator><creator>Köckerling, Ferdinand</creator><creator>Pession, Ursula</creator><creator>Hofmann, Anna</creator><creator>Albertsmeier, Markus</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5830-3536</orcidid><orcidid>https://orcid.org/0000-0002-5028-5062</orcidid></search><sort><creationdate>20220816</creationdate><title>Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial</title><author>Fortelny, René H ; Andrade, Dorian ; Schirren, Malte ; Baumann, Petra ; Riedl, Stefan ; Reisensohn, Claudia ; Kewer, Jan Ludolf ; Hoelderle, Jessica ; Shamiyeh, Andreas ; Klugsberger, Bettina ; Maier, Theo David ; Schumacher, Guido ; Köckerling, Ferdinand ; Pession, Ursula ; Hofmann, Anna ; Albertsmeier, Markus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-dd5a8bd040a7e78cd45f697e4355dc5232a7dbbec6202e0111f1d0fba779e9653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdominal Wound Closure Techniques</topic><topic>Adult</topic><topic>Editor's Choice</topic><topic>Humans</topic><topic>Incisional Hernia - surgery</topic><topic>Laparotomy - methods</topic><topic>Prospective Studies</topic><topic>Randomized Clinical Trial</topic><topic>Suture Techniques</topic><topic>Sutures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fortelny, René H</creatorcontrib><creatorcontrib>Andrade, Dorian</creatorcontrib><creatorcontrib>Schirren, Malte</creatorcontrib><creatorcontrib>Baumann, Petra</creatorcontrib><creatorcontrib>Riedl, Stefan</creatorcontrib><creatorcontrib>Reisensohn, Claudia</creatorcontrib><creatorcontrib>Kewer, Jan Ludolf</creatorcontrib><creatorcontrib>Hoelderle, Jessica</creatorcontrib><creatorcontrib>Shamiyeh, Andreas</creatorcontrib><creatorcontrib>Klugsberger, Bettina</creatorcontrib><creatorcontrib>Maier, Theo David</creatorcontrib><creatorcontrib>Schumacher, Guido</creatorcontrib><creatorcontrib>Köckerling, Ferdinand</creatorcontrib><creatorcontrib>Pession, Ursula</creatorcontrib><creatorcontrib>Hofmann, Anna</creatorcontrib><creatorcontrib>Albertsmeier, Markus</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fortelny, René H</au><au>Andrade, Dorian</au><au>Schirren, Malte</au><au>Baumann, Petra</au><au>Riedl, Stefan</au><au>Reisensohn, Claudia</au><au>Kewer, Jan Ludolf</au><au>Hoelderle, Jessica</au><au>Shamiyeh, Andreas</au><au>Klugsberger, Bettina</au><au>Maier, Theo David</au><au>Schumacher, Guido</au><au>Köckerling, Ferdinand</au><au>Pession, Ursula</au><au>Hofmann, Anna</au><au>Albertsmeier, Markus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2022-08-16</date><risdate>2022</risdate><volume>109</volume><issue>9</issue><spage>839</spage><epage>845</epage><pages>839-845</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Abstract
Background
Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.
Methods
A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome.
Results
The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173).
Conclusion
The 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches.
Registration number: NCT01965249 (http://www.clinicaltrials.gov)
This randomized clinical trial revealed no statistically significant difference in incisional hernia rate 1 year after laparotomy closure with short or long stitches. We found low hernia rates in both groups of this trial using an ultra-long-term absorbent elastic suture material.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35707932</pmid><doi>10.1093/bjs/znac194</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5830-3536</orcidid><orcidid>https://orcid.org/0000-0002-5028-5062</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2022-08, Vol.109 (9), p.839-845 |
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| source | MEDLINE; Oxford Journals |
| subjects | Abdominal Wound Closure Techniques Adult Editor's Choice Humans Incisional Hernia - surgery Laparotomy - methods Prospective Studies Randomized Clinical Trial Suture Techniques Sutures |
| title | Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial |
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