WE5.7 A Comparison of Small and Large Bites Closure of Fascia in Midline Laparotomy Wounds: Experience in a District General Hospital

Abstract

Abstract Aims Small bites (SBC) laparotomy closure (5mm fascial bites, 5mm apart) is thought to decrease incisional hernia rates compared to large bites (LBC) closure (1cm bites, 1cm apart). A colorectal surgeon in our centre changed practice following the STITCH trial. We aimed to assess whether this change affected outcomes. Methods All midline laparotomy patients immediately before and after the change in practice in 2017 were considered for inclusion. Data on demographics, co-morbidities, operation details, length of stay (LoS), complications and outcome were gathered from operation notes and electronic patient records. Follow up was censored at 12 months to make groups comparable. Results 80 patients were included (38 SBC; 42 LBC), undergoing laparotomy from August 2014-December 2020. Age, gender and ASA grade were comparable between groups. 58% SBC; 71% LBC were emergency cases. LoS was 7 days (range 3–166) for SBC; 11 (5–369) LBC. Overall wound complication rates were similar (23.7% SBC; 19% LBC, p=0.61). There were 4 (10.5%) burst abdomens following SBC and 2 (4.8%) following LBC (p=0.21). 1 (2.6%) SBC and 3 (7.1%) LBC developed incisional hernia at 12 months. Conclusions SBC did not result in decreased wound complications: although incisional hernia rate and LoS were reduced, there was a (non-significant) higher rate of burst abdomens in SBC. The latter may reflect a learning curve effect of a new technique. This study suggests SBC is feasible in a DGH, but long-term outcomes of SBC are yet to become apparent, which may have affected results in this cohort.