Prevention of incisional hernia with a reinforced tension line (RTL) versus primary suture only in midline laparotomies: 3-year follow-up in a randomized clinical trial

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2022-04, Vol.26 (2), p.447-456
• Main Authors: Lozada-Hernández, E. E., Mayagoitía-González, J. C., Smolinski-Kurek, R. L., Montiel-Hinojosa, L., Hernández-Villegas, L., Morales-Vargas, J. M., Pérez-Sánchez, K. D., Orozco-Mosqueda, A., Cano-Rosas, M.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Abdominal Wound Closure Techniques - adverse effects; Clinical trials; Follow-Up Studies; Hematoma; Hernia; Hernias; Herniorrhaphy - adverse effects; Humans; Incisional Hernia - epidemiology; Incisional Hernia - etiology; Incisional Hernia - prevention & control; Laparotomy; Laparotomy - adverse effects; Laparotomy - methods; Medicine; Medicine & Public Health; Original Article; Patients; Risk groups; Surgical site infections; Suture Techniques - adverse effects; Sutures; Sutures - adverse effects
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-020-02338-9

Purpose Incisional hernia (IH) has an incidence of 10–23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy. Methods Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed. Results A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) ( p  = 0.016, OR 0.35, 95% CI 0.14–0.88, number needed to treat 5.4, log-rank test p  = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. Conclusions The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. Trial registration Local Committee CI-HRAEB-2013-020. March 13, 2013. Clinical trials NCT02136628, retrospectively registered.