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

• 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
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.16567

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.