Department of Surgery, Sibu Hospital, Sibu, Malaysia.
Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
ANZ J Surg. 2021 May;91(5):896-901. doi: 10.1111/ans.16567. Epub 2021 Feb 1.
Conventional mass closure uses suture-to-wound length ratio of 4:1 ('long stitch', LS). 'Short stitch' (SS) has a suture-to-wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post-operative pain after laparotomy closure using LS and SS.
Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post-operative patient-controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi-squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann-Whitney U-test.
Eighty-six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient-controlled analgesia morphine usage 24 h post-operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P = 0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P = 0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P = 0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P = 0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference.
There were no differences in post-operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome.
传统的切口关闭采用缝线与切口长度比为 4:1（“长缝合法”，LS）。“短缝合法”（SS）的缝线与切口长度比大于 4，仅缝合白线，这可能会减少张力和疼痛。我们比较了 LS 和 SS 用于剖腹手术后的疼痛。
2017 年 2 月至 2018 年 9 月，在两家三级医院通过标准化切口行择期中线剖腹术的患者被随机分为 LS 或 SS 组。主要结局是术后 24 小时患者自控镇痛吗啡用量。次要结局为手术部位感染和住院时间（LOHS）。采用卡方检验分析分类变量。研究结果进行正态分布检验。偏态数据采用 Mann-Whitney U 检验分析。
共纳入 86 例患者（SS 组 42 例，LS 组 44 例）。中位年龄为 66 岁（四分位距（IQR）15）。大多数为男性（62.8%）和中国人（50%）。切口长度中位数在两组均为 17cm。术后 24 小时患者自控镇痛吗啡用量中位数无显著差异（SS 组 21mg，IQR 28.3；LS 组 18.5mg，IQR 33.8，P=0.829）。两组术后静息时疼痛评分中位数（SS 组 1，IQR 1；LS 组 1，IQR 2，P=0.426）和运动时疼痛评分中位数（SS 组 3，IQR 1；LS 组 3，IQR 2，P=0.307）无显著差异。SS 组 LOHS 较短（SS 组 6，IQR 4；LS 组 8，IQR 5，P=0.034）。SS 组手术部位感染率较低，但差异无统计学意义。
SS 和 LS 组术后疼痛无差异，但我们发现 SS 组的 LOHS 较短，这是次要结局。
