In elective surgery, it is well documented that a midline laparotomy should be closed with a slowly absorbable monofilament suture material in a continuous technique, in a ratio of at least 4 : 1. The evidence concerning the suture material or suturing technique in the emergency setting is lacking. We aimed to investigate whether this technique would reduce the rate of dehiscence.
A standardized procedure of closing the midline laparotomy by using a “small steps” technique of continuous suturing with a slowly absorbable (polydioxanone) suture material in a wound-suture ratio of minimum 1 : 4 was introduced in June 2014. All patients scheduled for any gastrointestinal emergency midline laparotomy were included until October 2015. Pre-, intra-, and postoperative data were registered. All emergency laparotomies performed from 2009 to 2013 served as reference. Chi-squared tests and multivariate Cox regression analysis were performed.
We included 494 patients from 2014 to 2015 and 1079 patients from our historical cohort for comparison. All patients had a midline laparotomy in an emergency setting. The rate of dehiscence was reduced from 6.6% to 3.8%, P = 0.03 comparing year 2009 to 2013 with 2014 to 2015. Factors associated with dehiscence were male gender [hazard ratio (HR) 2.8, 95% confidence interval (95% CI) (1.8–4.4), P < 0.001], performance status ≥3 [HR 2.1, 95% CI (1.2–3.7), P = 0.006], cirrhosis [HR 3.8, 95% CI (1.5–9.5), P = 0.004], and retention sutures [HR 2.8, 95% CI (1.6–4.9), P < 0.000]. The 30-day mortality rate was 18.4% in the standardized group vs 22.4% in 2009 to 2013, P = 0.057 and 90-day mortality 24.2% vs 30.4%, P = 0.008.
The standardized procedure of closing the midline laparotomy by using a “small steps” technique of continuous suturing with a slowly absorbable (polydioxanone) suture material reduces the rate of fascial dehiscence.
Supplemental Digital Content is available in the text
*Department of Gastrointestinal Surgery, Copenhagen University Hospital, Herlev, Denmark
†Zealand University Hospital. Dept. Surgery, Center for Surgical Science, Copenhagen University, Koege, Denmark.
Reprints: Mai-Britt Tolstrup, MD, Rosenvaenget 3, DK-3480 Fredensborg, Denmark. E-mail: email@example.com.
The authors report no conflicts of interest.
This study was not supported by any funding.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).