Introduction To examine the effect of fascia closure using barbed suture on incisional hernia in patients who underwent midline laparotomy for gynecological disease.
Methods 174 patients undergoing midline laparotomy for gynecologic disease, BMI<35, age>18 years and ECOG performance status 0–2 were 1:1 randomized to case (facial closure using barbed suture) vs. control (facial closure using non-barbed suture) group at 9 institutes in Korea, from February 2021 to December 2021. We compared the incidence of incisional hernia up to 1-year post-surgery between case and control group.
Results Of 174 patients (case 86, control 88), 36 patients were excluded because they were not followed till 1 year (case 19, control 17). No incisional hernia was observed in excluded 36 patients till last visit. Remaining 138 patients (case 67, control 71) were included in this analysis and all patients underwent fascial closure as assigned. Baseline and surgical variables including portion of cancer surgery (51/67 [76.1%] vs. 62/71 [87.3%]; p=0.088), mean wound length (24.3 cm vs. 25.1 cm; p=0.587) and mean surgery time (219.4 minutes vs. 243.2 minutes; p=0.257) were balanced. The incidence of incisional hernia up to 1-year post-surgery was similar between case and control groups (0/67 [0.0%] vs. 1/71 [1.4%]; p>0.999). No treatment-related adverse events other than incisional hernia, pain, wound infection and dehiscence were reported.
Conclusion/Implications Fascia closure using barbed suture showed zero incisional hernia up to 1 year in patients who underwent midline laparotomy for gynecological disease, but fail to reduce incisional hernia compared to conventional method.
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