A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer.
OBJECTIVE
To address the incidence of deep wound dehiscence and incisional hernia formation with two types of mass closure after vertical midline laparotomy performed in patients with gynecologic cancer.


METHODS
Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. Of the 614 subjects who could be evaluated, 308 underwent a continuous, non-locking closure with looped polyglyconate suture, and 306 were closed with interrupted polyglycolic acid according to the Smead-Jones technique.


RESULTS
Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infection (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follow-up period was 6 months to 3 years. No patient had evidence of chronic sinus drainage. Thirty-two (10.4%) of the patients who had the continuous closure and 45 (14.7%) of those who were closed with the interrupted method had evidence of incisional hernia (P = .14). No hernia developed in any patient with a wound infection. Four (1.3%) hernias after the continuous closure and eight (2.6%) after the interrupted closure required surgical repair because of patient discomfort (P = .38).


CONCLUSIONS
The interrupted closure was not superior to the continuous closure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster.
Colombo
M
M
Department of Obstetrics and Gynecology, Third Branch of the University of Milan, San Gerardo Hospital, Monza, Italy.
Maggioni
A
A
Parma
G
G
Scalambrino
S
S
Milani
R
R
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006555:Hernia, Ventral / Q000209:etiology; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects; D008875:Middle Aged; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques / Q000191:economics / Q000592:standards*; D013997:Time Factors; D014945:Wound Healing