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Randomized Controlled Trial
. 2024 Aug;28(4):1283-1291.
doi: 10.1007/s10029-024-03025-9. Epub 2024 Mar 27.

Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial

R H Fortelny  1   2 , A Hofmann  3 , P Baumann  4 , S Riedl  5 , J L Kewer  6 , J Hoelderle  6 , A Shamiyeh  7 , B Klugsberger  7 , T D Maier  8 , G Schumacher  9 , F Köckerling  10 , Ursula Pession  11 , M Schirren  3 , M Albertsmeier  3
Affiliations
Randomized Controlled Trial

Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial

R H Fortelny et al. Hernia. 2024 Aug.

Abstract

Background: Clinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial.

Methods: The ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint.

Results: The 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112-2.8485]; p = 0.31).

Conclusion: Hernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique.

Trial registry: NCT01965249, registered on 18 October 2013.

Keywords: Incisional hernia; Laparotomy; Prevention; Short stitches; Small bites; Randomised-controlled trial.

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Conflict of interest statement

Participating institutions received case payments from Aesculap AG to cover the study costs. P.B. is an employee of Aesculap AG. F.K. reports personal fees from BD Bard outside the submitted work. R.F. reports personal fees from Aesculap AG during the conduct of the study, as well as personal fees from Aesculap AG and BD BARD outside the submitted work. M.A. reports personal fees from Aesculap AG during the conduct of the study, as well as personal fees from Aesculap AG outside the submitted work. The remaining authors declare no other conflicts of interest.

Figures

Fig. 1
Fig. 1
CONSORT flow chart ESTOIH 3 years
Fig. 2
Fig. 2
Incisional hernia incidence
Fig. 3
Fig. 3
A QoL short-stitch group 3 years postop, B QoL long-stitch group 3 years postop
See this image and copyright information in PMC

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