Fascia closure after midline laparotomy: Results of a randomized trial

TLDR

A prospective multicentre randomized trial compared four midline laparotomy fascia closure techniques: interrupted polyglactin, continuous polyglactin, continuous polydioxanone, and continuous nylon. The trial found no difference in early infection or dehiscence rates among the four techniques, but at one year nylon closure was associated with higher wound pain and suture sinuses, while yielding the lowest incisional hernia rate (10.3 %) compared to higher rates in the other methods.

Abstract

Abstract Four techniques to close the fascia after midline laparotomy were compared in a prospective randomized multicentre trial. The four techniques were: interrupted closure with polyglactin; continuous closure with polyglactin; continuous closure with polydioxanone-s, and continuous closure with nylon. The early postoperative results in 1491 patients revealed an incidence of wound infection of 8·6 per cent and of wound dehiscence of 2·3 per cent with no statistically significant differences between the four techniques. We reviewed 1156 patients after 1 year. Wound pain was present in 9·7 per cent of the patients, statistically significantly more in the group closed with nylon (16·7 per cent). Suture sinuses developed in 3·5 per cent of the patients, statistically significantly more frequently in the nylon group (7·7 per cent). The total number of incisional hernias detected 1 year postoperatively was high (15·2 per cent) (interrupted polyglactin 16·9 per cent, continuous polyglactin 20·6 per cent, continuous polydioxanone 13·2 per cent and continuous nylon 10·3 per cent). The difference between nylon and continuous polyglactin is statistically significant. The results of this trial indicate that although nylon has the lowest incidence of incisional hernia it also is associated with more wound pain and suture sinuses.