Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey.
Department of Biostatistics, Selcuk University, Konya, Turkey.
Br J Surg. 2024 Aug 2;111(8). doi: 10.1093/bjs/znae189.
Incisional hernia is frequently observed after open colorectal cancer surgery, and should be considered a serious short- and long-term health issue. The present study evaluated the efficacy of small-bite abdominal closure in reducing the incidence of incisional hernia in this patient group.
An RCT was conducted between June 2019 and June 2022. A total of 173 patients who underwent open colorectal cancer surgery were assigned randomly to one of two groups to undergo fascial closure with either small bites (87) or conventional bites (86). The incisional hernia rate was accepted as the primary outcome, and surgical-site infection as the secondary outcome.
The incisional hernia rates at 1 year were 7 and 27% in the small- and conventional-bite groups respectively (P < 0.001). This rate increased to 9 and 31% at the end of the second year (P < 0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P = 0.03). Compared with the conventional-bite group, the small-bite group had higher suture/wound length ratios (mean(s.d.) 5.18(0.84) versus 3.67(0.57); P < 0.001) and a longer fascial closure time 14.1(4.64) versus 12.9(2.39) min; P = 0.03).
Small-bite closure with 5-mm tissue bites placed 5 mm apart reduced the incidence of incisional hernia and surgical-site infection after open colorectal cancer surgery.
切口疝是开放式结直肠癌手术后常见的并发症，应被视为严重的短期和长期健康问题。本研究评估了小切口腹部关闭技术在降低该患者组切口疝发生率方面的疗效。
一项 RCT 于 2019 年 6 月至 2022 年 6 月进行。共有 173 例接受开放式结直肠癌手术的患者被随机分配至两组，分别采用小切口（87 例）或常规切口（86 例）进行筋膜关闭。切口疝发生率被接受为主要结局，手术部位感染为次要结局。
小切口组和常规切口组 1 年时的切口疝发生率分别为 7%和 27%（P<0.001）。第二年结束时，这一比例分别上升至 9%和 31%（P<0.001）。小切口组的手术部位感染发生率为 18%，常规切口组为 31%（P=0.03）。与常规切口组相比，小切口组的缝合/伤口长度比更高（平均（标准差）5.18（0.84）比 3.67（0.57）；P<0.001），筋膜关闭时间也更长[14.1（4.64）比 12.9（2.39）min；P=0.03]。
采用 5-mm 组织切口、间隔 5mm 进行小切口关闭可降低开放式结直肠癌手术后切口疝和手术部位感染的发生率。
