Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2024-08, Vol.28 (4), p.1283-1291
• Main Authors: Fortelny, R. H., Hofmann, A., Baumann, P., Riedl, S., Kewer, J. L., Hoelderle, J., Shamiyeh, A., Klugsberger, B., Maier, T. D., Schumacher, G., Köckerling, F., Pession, Ursula, Schirren, M., Albertsmeier, M.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Abdominal Wound Closure Techniques; Aged; Clinical trials; Double-Blind Method; Elective Surgical Procedures; Fascia; Female; Follow-Up Studies; Hernia; Hernia, Ventral - surgery; Hernias; Humans; Hydroxybutyrates; Incisional Hernia - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT01965249; Original; Original Article; Patients; Polyesters; Prospective Studies; Suture Techniques; Sutures; γ-Hydroxybutyric acid
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-024-03025-9

Background Clinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial. Methods The ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint. Results The 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p  = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112–2.8485]; p  = 0.31). Conclusion Hernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique. Trial registry NCT01965249, registered on 18 October 2013.