RT Journal Article
SR Electronic
T1 Small bite fascial closure technique reduces incisional hernia rates in gynecologic oncology patients
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP ijgc-2023-004966
DO 10.1136/ijgc-2023-004966
A1 Straubhar, Alli M
A1 Stroup, Cynthia
A1 Manorot, Amanda
A1 McCool, Kevin
A1 Rolston, Aimee
A1 Reynolds, R Kevin
A1 McLean, Karen
A1 de Bear, Olivia
A1 Siedel, Jean
A1 Uppal, Shitanshu
YR 2024
UL http://ijgc.bmj.com/content/early/2024/04/19/ijgc-2023-004966.abstract
AB Background The potential for the technique of small bite fascial closure in mitigating incisional hernias in gynecologic oncology patients still needs to be investigated.Objective To evaluate the impact of closure of small fascial bites compared with prior standard closure on incisional hernia rates in gynecologic oncology patients.Methods This is a retrospective cohort study comparing patient outcomes before and after the intervention at a single institution at a comprehensive cancer center. Patients who underwent laparotomy with a vertical midline incision for a suspected or known gynecologic malignancy with a 1-year follow-up were included. The pre-intervention cohort (large bites) had ‘mass’ or modified running Smead-Jones closure. In contrast, the post-intervention cohort had fascial bites taken 5–8 mm laterally with no more than 5 mm travel (small bites) closure using a 2–0 polydioxanone suture.The primary outcome was the incisional hernias rate determined by imaging or clinical examination within the first year of follow-up. Patient factors and peri-operative variates of interest were investigated for their association with hernia formation through univariate and multivariate analyses. These included age, body mass index (BMI), smoking history, estimated blood loss, pre-operative albumin, American Society of Anesthesia (ASA) physical status classification, or treatment with chemotherapy post-operatively.Results Of the 255 patients included, the total hernia rate was 12.5% (32/255 patients). Patient characteristics were similar in both cohorts. Small bite closure led to a significant reduction in hernia rates from 17.2% (22/128 patients) to 7.9% (10/127 patients), p=0.025. According to logistic regression modeling, small bite closure (OR=0.40, 95% CI 0.17 to 0.94, p=0.036) was independently associated with lower odds of hernia formation. Other factors associated with increased hernia rates were chemotherapy (OR=3.22, 95% CI 1.22 to 8.51, p=0.019) and obesity (OR=23.4, 95% CI 3.09 to 177, p=0.002). In obese patients, small bite closures led to maximal hernia rate reduction compared with large bites.Conclusions The small bite closure technique effectively reduces hernia rates in gynecologic oncology patients undergoing midline laparotomy.All data relevant to the study are included in the article or uploaded as supplementary information.