Prophylactic retention sutures in midline laparotomy in high-risk patients for wound dehiscence: a randomized controlled trial

Abstract

Background: Abdominal wound dehiscence (WD) is a postoperative complication with high mortality and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence. The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy using prophylactic retention sutures in high-risk patients.

Materials and methods: Three hundred high-risk patients with at least two risk factors for dehiscence who underwent midline laparotomy between 2008 and 2010 were randomly divided into two groups. In the control group, the fascia was continuously repaired using a running looped #1 nylon suture. For the intervention group, we added retention sutures that included the skin, subcutaneous tissue, rectus muscle, and abdominal fascia. We compared the rates of WD, evisceration, wound infection, postoperative pain, postdehiscence mortality, and late incisional hernia for these two groups.

Results: After accounting for early mortalities, 147 patients were followed in the intervention group and 148 patients in the control group. WD occurred in 6 patients (4%) in the intervention group and 20 control patients (13.3%) (P = 0.007). Abdominal evisceration after surgery occurred in 1 patient (0.7%) with retention sutures and 4 control patients (2.7%) (P = 0.371). There was no significant difference in wound infection and incisional hernia between the two groups. Postoperative pain scores between the two groups did not differ significantly during the first 3 d, but did differ on the fourth day.

Conclusion: Prophylactic retention sutures reduce the occurrence of WD following midline laparotomy in high-risk patients with multiple risk factors for impaired wound healing without imposing remarkable postoperative complications.