Faculty Collaboration Database

Interrupted versus continuous fascial closure in patients undergoing emergent laparotomy: A randomized controlled trial. J Trauma Acute Care Surg 2018 Sep;85(3):459-465

Date

05/23/2018

Pubmed ID

29787547

DOI

10.1097/TA.0000000000001970

Scopus ID

2-s2.0-85052754660 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: The optimal method of fascial closure, interrupted fascial closure (IFC) versus continuous fascial closure (CFC) has never been studied exclusively in the setting of emergency surgery. We hypothesized that IFC decreases postoperative incisional hernia development following emergent laparotomies.

METHODS: Between August 2008 and September 2015, patients undergoing emergent laparotomies were consented and randomly assigned to either IFC or CFC. Patients were followed up postoperatively for at least 3 months and assessed for incisional hernia, dehiscence, or wound infection. We excluded those with trauma, elective surgery, mesh in place, primary ventral hernia, previous abdominal surgery within 30 days, or those not expected to survive for more than 48 hours. Our primary endpoint was the incidence of postoperative incisional hernias.

RESULTS: One hundred thirty-six patients were randomly assigned to IFC (n = 67) or CFC (n = 69). Baseline characteristics were similar between the groups. No difference was noted in the length of the abdominal incision, or the peak inspiratory pressure after the closure. The median time needed for closure was significantly longer in the IFC group (22 minutes vs. 13 minutes, p < 0.001). Thirty-seven (55.2%) IFC and 41 (59.4%) CFC patients completed their follow-up visits. There was no statistically significant difference in baseline and intraoperative characteristics between those who completed follow-ups and those who did not. The median time from the day of surgery to the day of the last follow-up was similar between IFC and CFC (233 days vs. 216 days, p = 0.67), as were the rates of incisional hernia (13.5% versus 22.0%, p = 0.25), dehiscence (2.7% vs. 2.4%, p = 1.0), and surgical site infection (16.2% vs. 12.2%, p = 0.75).

CONCLUSION: There was no statistically detectable difference in postoperative hernia development between those undergoing IFC versus CFC after emergent laparotomies. However, this may be due to the relatively low sample size.

LEVEL OF EVIDENCE: Therapeutic/Care Management Study, level III.

Author List

Peponis T, Bohnen JD, Muse S, Fuentes E, van der Wilden GM, Mejaddam A, Alam H, Kaafarani HMA, Fagenholz PJ, King DR, Yeh DD, Velmahos GC, de Moya MA

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdominal Wound Closure Techniques
Aged
Aged, 80 and over
Emergency Treatment
Fascia
Fasciotomy
Female
Hernia, Ventral
Humans
Incidence
Incisional Hernia
Laparotomy
Male
Middle Aged
Postoperative Complications
Surgical Wound Infection