• Annals of surgery · Nov 2021

    Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions: First Results of a Randomized Controlled Trial.

    • Michał Grąt, Marcin Morawski, Maciej Krasnodębski, Jan Borkowski, Piotr Krawczyk, Karolina Grąt, Jan Stypułkowski, Bartosz Maczkowski, Wojciech Figiel, Zbigniew Lewandowski, Konrad Kobryń, Waldemar Patkowski, Marek Krawczyk, Tadeusz Wróblewski, Włodzimierz Otto, Rafał Paluszkiewicz, and Krzysztof Zieniewicz.
    • Department of General, Transplant and Liver Surgery, Warsaw, Poland.
    • Ann. Surg. 2021 Nov 1; 274 (5): 690697690-697.

    ObjectiveTo compare the early results of mass and layered closure of upper abdominal transverse incisions.Summary Of Background DataContrary to midline incisions, data on closure of transverse abdominal incisions are lacking.MethodsThis is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisional-SSI) was the primary end-point. Secondary end-points comprised suture-to-wound length ratio (SWLR), closure duration, and fascial dehiscence (clinicatrials.gov NCT03561727).ResultsA total of 268 patients were randomized to either mass (n=134) or layered (n=134) closure. Incisional-SSIs occurred in 24 (17.9%) and 8 (6.0%) patients after mass and layered closure, respectively (P =0.004), with crude odds ratio (OR) of 0.29 [95% confidence interval (95% CI) 0.13-0.67; P =0.004]. Layered technique was independently associated with fewer incisional-SSIs (OR: 0.29; 95% CI 0.12-0.69; P =0.005). The number needed to treat, absolute, and relative risk reduction for layered technique in reducing incisional-SSIs were 8.4 patients, 11.9%, and 66.5%, respectively. Dehiscence occurred in one (0.8%) patient after layered closure and in two (1.5%) patients after mass closure (P >0.999). Median SWLR were 8.1 and 5.6 (P <0.001) with median closure times of 27.5 and 25.0 minutes (P =0.044) for layered and mass closures, respectively.ConclusionsLayered closure of upper abdominal transverse incisions should be preferred due to lower risk of incisional-SSIs and higher SWLR, despite clinically irrelevant longer duration.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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