Abstract
Abstract Aim Surgical technique and material used to close an abdominal wall incision are considered to be important determinants for the risk of developing surgical site occurences (SSOs). Aim of our prospective, non-randomized, monocentric study was a comparative analysis of the perioperative performance (6:1 suture/wound length (SL/WL)-ratio) and SSOs (surgical site infections [SSI] & 2°wound dehiscence/burst abdomen) following midline & transverse incisions. Material and Methods The trial is completed. It included 351 patients between 1/2013-10/2018 in a prospective database. The surgeons aimed at performing a 6:1 SL/WL-ratio in all laparotomies. Patient specific data (risk factors, intra- & postop parameters & SSI/SSO) were entered into the registry database. Satistics involved the Chi2-/ANOVA and Mann-Whitney Test. Results Overall, 82,3% (289/351) were operated electively, 17,7% (62/351) had an emergency laparotomy, 55% (n = 194) had a midline, 29% (n = 103) a transverse and 15% (n = 54) a combined L-shaped laparotomy (liver resection). A learning curve with respect to the bite width was encountered. While SL/WL ratio all laparotomies were similar, bite width varied but improved with experience. SSI was higher in transverse vs. median laparotomies and overall higher in emergency operations. The rate of 2°wound dehiscence (surgical site occurrence [SSO]) stayed at 1/351. Conclusions A learning curve is required to sufficiently perform a short stitch 6:1 suture. Median and transverse laparotomies can be closed safely by a 6:1 SL/WL ratio. SSO could be reduced compared to our historic patient cohort but did not differ within the > and < 6:1 ratio. Emergency laparotomies can also be safely performed with the short stitch technique.
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