6:1 Suture/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.