Sekhar Sulakshana, Ekka Nishith M, Nair Rahul, Pratap Vinay, Mundu Mrityunjay, Kumar Amit
General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND.
Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND.
Cureus. 2023 Feb 10;15(2):e34840. doi: 10.7759/cureus.34840. eCollection 2023 Feb.
The development of an incisional hernia is a common complication of midline laparotomy. Improper fascial closure techniques have a significant role in its development. It can also lead to poor wound healing and increase the risk of developing surgical site infections (SSI). Upon conducting a thorough literature review, various studies have been conducted on closing abdominal wounds. However, there is a dearth of studies portraying the role of suture length in the prevention of incisional hernia and SSI. The effect of using a greater suture-to-wound length ratio on postoperative outcomes was not clearly analyzed or described. The objective of this study is to assess the effectiveness of using a suture length to wound length ratio ≥4:1 versus a ratio <4:1 in preventing postoperative complications such as incisional hernia and SSI. This study is a systematic review of randomized controlled trials on abdominal wound closure using a suture length to wound length ratio of ≥4:1 and <4:1. published in PubMed, Google Scholar, and Cochrane library. The inclusion and exclusion criteria were defined. The relevant studies identified from 1991 to 2017, were included in the analysis. The primary endpoint was the incidence of incisional hernia, and the secondary outcome was the incidence of SSI. This meta-analysis considered five randomized controlled trials that compared the effects of using different suture length to wound length ratios during abdominal closure on incisional hernia and SSI. Participants ranged in size from 100 to 363. The trial follow-up period ranged from a minimum of 10 months to five years. The outcomes studied in the two groups were incisional hernia and SSI. The relative risk of the occurrence of incisional hernia if the suture length to wound length ratio was ≥4:1 was 0.42 with a p-value of <0.001 which was considered significant. This implied that using a suture length of more than four times that of the wound i.e., 4:1, significantly decreases the risk of developing an incisional hernia by more than half. The relative risk of developing a SSI was 0.98 with a p-value of 0.966. Thus, this method of abdominal closure uing a longer suture length to wound length ratio does not contribute to an increased incidence or significant change in the risk of developing SSI.
切口疝的发生是中线剖腹手术常见的并发症。不当的筋膜缝合技术在其发生过程中起着重要作用。它还会导致伤口愈合不良，并增加手术部位感染（SSI）的风险。在进行全面的文献综述时，已经开展了多项关于腹部伤口缝合的研究。然而，缺乏描述缝线长度在预防切口疝和SSI方面作用的研究。使用更大的缝线与伤口长度比 对术后结果的影响尚未得到明确分析或描述。本研究的目的是评估使用缝线长度与伤口长度比≥4:1 与<4:1 预防术后并发症（如切口疝和SSI）的有效性。本研究是对发表在PubMed、谷歌学术和Cochrane图书馆上的使用缝线长度与伤口长度比≥4:1 和<4:1 进行腹部伤口缝合的随机对照试验的系统评价。定义了纳入和排除标准。对1991年至2017年确定的相关研究进行分析。主要终点是切口疝的发生率，次要结果是SSI的发生率。这项荟萃分析纳入了五项随机对照试验，这些试验比较了腹部缝合时使用不同缝线长度与伤口长度比对切口疝和SSI的影响。参与者人数从100到363不等。试验随访期从最短10个月到五年不等。两组研究的结果是切口疝和SSI。如果缝线长度与伤口长度比≥4:1，发生切口疝的相对风险为0.42，p值<0.001，被认为具有显著性。这意味着使用超过伤口四倍长度的缝线，即4:1，可显著降低发生切口疝的风险一半以上。发生SSI的相对风险为0.98，p值为0.966。因此，这种使用较长缝线长度与伤口长度比的腹部缝合方法不会导致SSI发生率增加或风险发生显著变化。
