Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden.
Br J Surg. 2024 Sep 3;111(10). doi: 10.1093/bjs/znae265.
The aim was to investigate whether adding a reinforced tension-line (RTL) suture to a standard 4 : 1 small-bite closure would reduce the incidence of incisional hernia after colorectal cancer surgery.
Patients aged at least 18 years, who were scheduled for elective colorectal cancer surgery through a midline incision at two Swedish hospitals (2017-2021), were randomized in a 1 : 1 ratio to either fascial closure with RTL and 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure with polydioxanone suture alone (PDS group). The primary outcome was CT-detected incisional hernia 1 year after surgery. CT interpreters were blinded regarding treatment group.
In all, 160 patients were randomized, 80 in each group. The study closed early to recruitment and follow-up. Some 134 patients were analysed at 1 year: 63 in the RTL group and 71 in the PDS group. Nineteen patients were found to have an incisional hernia: 4 (6%) in the RTL group and 15 (21%) in the PDS group (OR 3.95, 95% c.i. 1.24 to 12.60; P = 0.014). No unintended effects were found in either group.
Adding an RTL suture at fascial closure decreased the incidence of incisional hernia in patients undergoing surgery for colorectal cancer. Trial registration: NCT03390764 (https://clinicaltrials.gov).
本研究旨在探讨在标准的 4 比 1 小切口关闭术基础上，增加强化缝线（RTL）是否能降低结直肠癌手术后切口疝的发生率。
2017 年至 2021 年，在瑞典的两家医院，选择至少 18 岁、接受择期结直肠癌手术且经正中切口入路的患者，按 1:1 的比例随机分为两组，一组接受 RTL 与 4 比 1 小切口关闭术（RTL 组），另一组接受单纯 4 比 1 小切口关闭术（PDS 组）。主要结局为术后 1 年 CT 检测到的切口疝。CT 解读者对治疗组不知情。
共纳入 160 例患者，每组 80 例。该研究因招募和随访提前结束。共有 134 例患者在术后 1 年时进行了分析：RTL 组 63 例，PDS 组 71 例。19 例患者出现切口疝：RTL 组 4 例（6%），PDS 组 15 例（21%）（OR 3.95，95%CI 1.24-12.60；P=0.014）。两组均未发现不良反应。
在结直肠癌手术患者的筋膜关闭术中增加 RTL 缝线可降低切口疝的发生率。
NCT03390764（https://clinicaltrials.gov）。
