Comparison of post‐operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: a double‐blind randomized controlled trial

Comparison of post‐operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: a double‐blind randomized controlled trial

Background Conventional mass closure uses suture‐to‐wound length ratio of 4:1 (‘long stitch’, LS). ‘Short stitch’ (SS) has a suture‐to‐wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post‐operative pain after laparotomy closu...

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Published in:ANZ journal of surgery Vol. 91; no. 5; pp. 896 - 901
Main Authors: Lai, Larry Weng‐Hong, Roslani, April Camilla, Yan, Yang‐Wai, Bhojwani, Kavita M., Jamaluddin, Mohamad Fadhil Hadi
Format: Journal Article
Language:English
Published: Melbourne John Wiley & Sons Australia, Ltd 01-05-2021
Blackwell Publishing Ltd
Subjects:
abdominal closure
Abdominal wall
Analgesia
Double-blind studies
general surgery
Infections
Laparotomy
Median (statistics)
Morphine
Normal distribution
Pain
Pain perception
Patients
Postoperative period
post‐operative pain
short stitch
Skewed distributions
Statistical analysis
surgical education
Surgical site infections
Sutures
Wounds
general surgery
abdominal closure
surgical education
post-operative pain
short stitch
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Summary:Background Conventional mass closure uses suture‐to‐wound length ratio of 4:1 (‘long stitch’, LS). ‘Short stitch’ (SS) has a suture‐to‐wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post‐operative pain after laparotomy closure using LS and SS. Methods Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post‐operative patient‐controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi‐squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann–Whitney U‐test. Results Eighty‐six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient‐controlled analgesia morphine usage 24 h post‐operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P = 0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P = 0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P = 0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P = 0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference. Conclusion There were no differences in post‐operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome. This study compared the post‐operative pain difference between short and long stitch techniques in elective laparotomy wound closure.
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ISSN:1445-1433
1445-2197
DOI:10.1111/ans.16567