Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, 81377, Munich, Germany.
Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria.
Hernia. 2022 Feb;26(1):87-95. doi: 10.1007/s10029-021-02410-y. Epub 2021 May 28.
The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material.
Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax). Here, we report short-term surgical outcomes.
At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768-1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379-0.6617), p = 0.0115].
Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique.
NCT01965249, registered October 18, 2013.
已有研究表明，经皮间断缝合技术（short-stitch technique）可降低切口疝发生率，但目前临床上仍以间断全层缝合（long-stitch technique）作为标准缝合技术，且经皮间断缝合技术对短期结果的影响尚未明确。本研究旨在使用超长效可吸收弹性缝线比较这两种缝合技术的效果。
在 9 家中心行择期经腹正中切口手术的 425 例患者被随机分为两组，分别使用超皮纹可吸收缝线（USP 2-0 单丝线）行经皮间断缝合（short-stitch 组，n=215）或聚 4-羟基丁酸酯缝线（Monomax）行间断全层缝合（long-stitch 组，n=210）。本研究报告短期手术结果。
术后 30（+10）天，short-stitch 组 3 例（1.40%）和 long-stitch 组 10 例（4.76%）患者发生切口裂开（burst abdomen）[比值比（OR）0.2830（0.0768-1.0433），p=0.0513]。两组均有少量缝线断裂、血清肿、血肿和其他伤口愈合不良的病例，但组间差异无统计学意义。在计划的 Cox 比例风险模型中，short-stitch 组发生切口裂开的风险显著降低[风险比（HR）0.1783（0.0379-0.6617），p=0.0115]。
尽管本试验未显示经皮间断缝合和间断全层缝合技术在经腹正中切口关闭方面的短期结果存在显著差异，但 short-stitch 组切口裂开发生率较低，提示该技术可能具有一定优势。
NCT01965249，2013 年 10 月 18 日注册。
