Burst abdomen and incisional hernia after major gastrointestinal operations--comparison of three closure techniques.
OBJECTIVE
To compare the incidence of burst abdomen and incisional hernia after three different techniques of closure of the abdominal wall after major gastrointestinal operations.


METHODS
Prospective, randomised, controlled trial.


METHODS
University hospital, Norway.


METHODS
599 adults who underwent major operations for gastrointestinal conditions between December 1990 and February 1992.


METHODS
Patients were randomised in three groups for abdominal wall closure by continuous mass polyglyconate (Maxon) double suture with loop, continuous mass polyglactin 910 (Vicryl), and interrupted polyglactin 910 (Vicryl) (layered for transverse and mass for midline incisions).


METHODS
Burst abdomen during the postoperative period, and incisional hernia after one year follow up.


RESULTS
The incidence of wound dehiscence was 2% and of incisional hernia at one year 7%. There were no differences in the rate of dehiscence among the groups, but there were significantly more hernias in the polyglyconate group (19/164, 12%) compared with the two in which polyglactin 910 was used (16/327, 5%). Wound infections developed in 84/583 of our patients (14%) and the incidence was closely associated with emergency operations and contamination. Wound complications were not associated with the closure technique.


CONCLUSIONS
Wound infection is the most important single factor in the development of burst abdomen and incisional hernia. The continuous closure technique is quicker, cheaper, and as safe as the interrupted technique.
Gislason
H
H
Department of Surgery, University of Bergen, Haukeland Hospital, Norway.
Grønbech
J E
JE
Søreide
O
O
D000368:Aged; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011108:Polymers; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures
D011108:Polymers; D011098:Polyglactin 910; C046409:polyglyconate