6:1 Suture or Wound length ratio with the short stitch technique – a reality check on practicability and short term outcome

Abstract

Aim: To analyze laparotomy closure of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. Method: Prospective, single centre, non randomised, controlled cohort study on short stitches with a longterm resorbable, elastic suture (material: poly-4-hydroxybutyrate) aiming at a 6:1 suture to wound (SL/WL) length ratio in midline and transverse, primary & secondary laparotomies for elective & emergency surgery. Results: We included 351 patients (♂: 208; ♀: 143), midline (n=194), transverse (n=103) and a combined midline/transverse L-shaped (n=54) incisions. There was no stitch performance quality difference between elective (n=296) and emergency (n=55) operations, while results in the first 150 patients showed a significantly reduced SL/WL-ratio to the following 200 suture closures (SL/WLratio: 5.64±2.5 vs 6.1±2.3, p<0.001). Average SL/WL-ratio in general was better for midline than transverse incision sutures (6.62±2.5 vs 4.3±1.51, p<0.001). SL/WL-ratio varied among the 6 surgeons participating, although results steadily improved and eventually approximated each other. Conclusions: We could show that a 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be significantly performed better in midline than transverse incisions. Transverse incisions should preferably be closed in 2 layers in order to achieve a sufficient SL/WL-ratio equivalent to the median incision. While on an individual level, results varied between surgeons, quality will improve and eventually approximate.

The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations

“…Technically, the short stitch group (ESTOIH) with a SL/WL-ratio of 5.3 ± 2.2 almost reached our targeted values and significantly exceeded the conventional 4:1 gold standard. Whether the material or the thread properties (elasticity) might have contributed to a lower hernia rate is speculative [ 16 , 18 ]. We encountered a positive feedback from the surgeons handling the thread.…”

“…The protocol for the suture technique was published previously in detail [ 18 ]. In brief, we counted the no.…”

“…In brief, we counted the no. of stitches, measured the wound length, the incorporated thread to calculate the suture to wound length ratio (SL/WL-ratio) and could then calculate the average lateral stitch distance (LSD) and the interval of the stitches (SI) which may vary substantially according to the technique [ 5 , 16 , 18 ]. Please note: Due to various reasons, the first 50 sutures (documentation) were insufficient and had to be discarded altogether.…”