• René H Fortelny, Dorian Andrade, Malte Schirren, Petra Baumann, Stefan Riedl, Claudia Reisensohn, Jan Ludolf Kewer, Jessica Hoelderle, Andreas Shamiyeh, Bettina Klugsberger, Theo David Maier, Guido Schumacher, Ferdinand Köckerling, Ursula Pession, Anna Hofmann, and Markus Albertsmeier.
• Wilhelminenspital, Allgemein, Viszeral und Tumorchirurgie, Vienna, Austria.
• Br J Surg. 2022 Aug 16; 109 (9): 839845839-845.

BackgroundIncisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.MethodsA prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome.ResultsThe trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173).ConclusionThe 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches. Registration number: NCT01965249 (http://www.clinicaltrials.gov).© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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