DOI: http://dx.doi.org/10.18203/2349-2902.isj20201529

Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

Rajat Sharma, Amitpal Kaur, Mohit Sharma, Karaninder Singh, Neeti Rajan Singh

Abstract


Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.

Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.

Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.

Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.


Keywords


Large bite, Small bite, Midline laparotomy, Incisional hernia, Pain, Wound infection

Full Text:

PDF

References


Nahai F, Brown RG, Vasconez LO. Blood supply to the abdominal wall as related to planning abdominal incisions. Am Surg. 1976;42:691-5.

Chawla S. A comparison between mass closure and layered closure of midline abdominal incisions. Med J DY Patil Univ. 2012;5:26-7.

Van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health- related quality of life and body image:a prospective cohort study. Am J Surg. 2012;204(2):144-50.

Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg. 1993;80(10):1284-6.

Hoer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg. 2002;73:474-80.

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, et al. European hernia society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1-24.

Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027-40.

Pollock AV, Evans M. Early prediction of late incisional hernias. Br J Surg. 1989;76(9):953-4.

Crichton N. Visual analogue scale (VAS). J Clin Nurs. 2001;10(5):706-6.

Mersheimer WL, Winfield JM. Abdominal wound disruption: A review of the etiology, recognition and management. Surg Clin North Am. 1955;35(2):471-85.

Singh A, Singh S, Dhaliwal US, Singh S. Technique of abdominal wall closure. IJS. 1981;11:785-9.

Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. The Lancet. 2015;386(10000):1254-60.

De Vries HS, Verhaak T, Van Boxtel TH, Van Den Heuvel W, Teixeira MB, Heisterkamp J, et al. Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections. Hernia. 2019: 1-5.

Gokani SA, Elmqvist KO, El-Koubani O, Ash J, Biswas SK, Rigaudy M. A cost-utility analysis of small bite sutures versus large bite sutures in the closure of midline laparotomies in the United Kingdom National Health Service. CEOR. 2018;10:105-17.

Williams Z, Hope W. Abdominal wound closure: current perspectives. Open Access Surg. 2015;8:89-94.

Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg. 1993;80(10):1284-6.

Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144(11):1056-9.