A randomized clinical trial comparing two methods of fascia closure following midline laparotomy
J. B. Trimbos, I. B. Smit, J. P. Holm and J. Hermans
Department of Gynecology, Leiden, The Netherlands.
Three hundred forty women undergoing midline laparotomy were randomized
into an interrupted suture (polyglactin 910, size 1) or a continuous suture
(polyglyconate, size 0) closure group. The two groups were well balanced
with respect to various risk factors for postoperative wound complications.
Early evaluation revealed no differences between the continuous and
interrupted suture groups with respect to wound infection (3% vs 1%),
superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs
0%). Late evaluation showed no differences between the two groups either.
Continuous polyglyconate and interrupted polyglactin 910 sutures had a
similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and
incisional hernia (3% vs 4%). Continuous closure was done faster and
resulted in less foreign-body suture material. Despite its smaller
diameter, the polyglyconate suture also retains a higher tensile strength
after surgery than does the quicker-degrading polyglactin 910 suture.
Results of this study lead to the conclusion that a running polyglyconate
suture is the better choice for closure of the abdominal-wall fascia
following midline laparotomy.
