O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL

Aim The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®). Material and Methods Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy. Results 425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142). Conclusions Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.

O14 SHORT STITCH TRIAL 6:1 WITH 4-OH-BUTYRATE (MONOMAX) - FINAL RESULTS

Aim Surgical technique and material used to close an abdominal wall incision are considered to be important determinants for the risk of developing surgical site occurences (SSOs). Aim of our prospective, non-randomized, monocentric study was a comparative analysis of the perioperative performance (6:1 suture/wound length (SL/WL)-ratio) and SSOs (surgical site infections [SSI] & 2°wound dehiscence/burst abdomen) following midline & transverse incisions. Material and Methods The trial is completed. It included 351 patients between 1/2013-10/2018 in a prospective database. The surgeons aimed at performing a 6:1 SL/WL-ratio in all laparotomies. Patient specific data (risk factors, intra- & postop parameters & SSI/SSO) were entered into the registry database. Satistics involved the Chi2-/ANOVA and Mann-Whitney Test. Results Overall, 82,3% (289/351) were operated electively, 17,7% (62/351) had an emergency laparotomy, 55% (n = 194) had a midline, 29% (n = 103) a transverse and 15% (n = 54) a combined L-shaped laparotomy (liver resection). A learning curve with respect to the bite width was encountered. While SL/WL ratio all laparotomies were similar, bite width varied but improved with experience. SSI was higher in transverse vs. median laparotomies and overall higher in emergency operations. The rate of 2°wound dehiscence (surgical site occurrence [SSO]) stayed at 1/351. Conclusions A learning curve is required to sufficiently perform a short stitch 6:1 suture. Median and transverse laparotomies can be closed safely by a 6:1 SL/WL ratio. SSO could be reduced compared to our historic patient cohort but did not differ within the > and < 6:1 ratio. Emergency laparotomies can also be safely performed with the short stitch technique.

Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial

Purpose The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material. Methods Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes. Results At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768–1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379–0.6617), p = 0.0115]. Conclusions Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique. Trial registry NCT01965249, registered October 18, 2013.

A study to evaluate the effects of various abdominal closure techniques on midline laparotomy wounds in a tertiary care hospital in West Bengal

Background: Post-operative complications of wound repair after laparotomy pose a major threat to life as well as to the health economy of a developing nation. Among many other factors, the length of suture used during wound closure has been studied for long. A prospective randomized control study comprising of 104 patients was conducted in the department of surgery of Bankura Sammilani medical college for comparing the incidence of SSI, wound dehiscence and incisional hernia after using short stitch and long stitch for repairing midline laparotomy wounds.Methods: Out of 104 patients enrolled in the study, 51 patients were randomly allocated to short stitch group (suture length: wound length>4:1) and 53 patients were allocated to long stitch group (suture length: wound length=4:1) and both the groups were subsequently followed up for development of the three complications.Results: Data analysis revealed that 11.7 % patients in short stitch group developed SSI whereas 24.5% patients in long stitch group developed SSI. Wound dehiscence occurred in 5.8 % of patients in short stitch group against 15% in long stitch group. 7.8% patients in short stitch group developed incisional hernia against 20.7% patients in long stitch group. In all three situations, p value was significant (<0.05).Conclusions: It is concluded from our study that, the rate of SSI, wound dehiscence and incisional hernia is significantly lower in midline abdominal wounds closed with short stitch length than those closed with long stitch length.

Replicating Captain Cook's Waistcoat: Exploring the Skills of a Named Embroiderer during the Eighteenth Century

This article discusses a project to replicate an unfinished waistcoat believed to have been embroidered in the late 1770s for Captain James Cook by his wife, Elizabeth. The intention was to explore the techniques of embroidery used during the eighteenth century, and to replicate a garment belonging to a major historical figure. The original waistcoat was embroidered on Tahitian tapa cloth with a linen backing. The embroidery used silk and metallic thread and silver-plated spangles, employing chain stitch, long-and-short stitch and tambouring. The replica was completed using materials closely approximating those available in the 1770s, and constructed using eighteenth-century methods. The project has shed light on the skills and abilities of a known amateur embroiderer of the late eighteenth century, in addition to providing insight into the tastes and physical characteristics of an important historical figure.