Barbed Suture for Emergency Midline Laparotomy Closure

Study Overview
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Brief Summary
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Urgency surgeries are often performed in a stressful setting with critical patient involved. In this context, laparotomy closure can sometimes be the most neglected part of the procedure. Barbed sutures, frequently used in laparoscopic procedures, have proven to be effective in maintaining traction. The aim of this study is to describe the incisional hernia rate after emergency midline laparotomy, according to the suture utilized, evaluated at one month and one year postoperative.

Detailed Description
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A retrospective cohort study was performed including patients with urgency midline laparotomy during 2018-2019. Group A was represented by patients with slowly absorbable monofilament continuous suture, while Group B included patients with barbed suture closure. Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging. Demographic characteristics, risk factors, among other descriptive determinations were registered. A total of 128 patients were performed an emergency midline laparotomies, and 110 meet all inclusion criteria. There was equality between sex and median age was 65 years old. Significative differences were observed regarding incisional hernia at 30 days, being less frequent when barbed suture was utilized. These differences were not present at the long-term reevaluation (one year). In conclusion, midline laparotomy closure must be performed within quality standards. The lack of studies regarding emergency laparotomy closure, the European Hernia Society stated that no recommendations can be given on this patients. Barbed suture appears as a promising option for closure in these specific circumstances, but needs further study.

Official Title
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Barbed Suture vs. Monofilament for Emergency Midline Laparotomy Closure, a Retrospective Analysis

Conditions
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Incisional Hernia of Midline of Abdomen

Intervention / Treatment
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* Procedure: Barbed


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Emergency laparotomy Minimum age of 18 years old. Digestive surgical disease. Minimum survival of one month postoperatively. Exclusion Criteria: Laparoscopic surgical procedure. Non-digestive surgical procedure (gynecology, urology...).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Monofilament closure<br>Patients with midline emergency laparotomy, which closure was performed with monofilament suture | |
| Barbed closure<br>Patients with midline emergency laparotomy, which closure was performed with barbed suture | Procedure: Barbed<br>* Efficacy of barbed and monofilament closure regarding incisional hernia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incisional Hernia 1 month | Incidence of incisional hernia at one month after surgery | Hernia 1 month | 
| Incisional Hernia 1 year | Incidence of incisional hernia at one year after surgery | Hernia 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surgical Site Infection | Incidence of postoperative surgical site infection | 1 month | 
| Evisceration | Incidence of early abdominal evisceration | 1 month | 
| Medical complications | Incidence of other medical complications | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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incisional hernia, midline laparotomy, urgency laparotomy, barbed suture, monofilament suture