A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer

Obstet Gynecol. 1997 May;89(5 Pt 1):684-9. doi: 10.1016/s0029-7844(97)00079-3.

Abstract

Objective: To address the incidence of deep wound dehiscence and incisional hernia formation with two types of mass closure after vertical midline laparotomy performed in patients with gynecologic cancer.

Methods: Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. Of the 614 subjects who could be evaluated, 308 underwent a continuous, non-locking closure with looped polyglyconate suture, and 306 were closed with interrupted polyglycolic acid according to the Smead-Jones technique.

Results: Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infection (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follow-up period was 6 months to 3 years. No patient had evidence of chronic sinus drainage. Thirty-two (10.4%) of the patients who had the continuous closure and 45 (14.7%) of those who were closed with the interrupted method had evidence of incisional hernia (P = .14). No hernia developed in any patient with a wound infection. Four (1.3%) hernias after the continuous closure and eight (2.6%) after the interrupted closure required surgical repair because of patient discomfort (P = .38).

Conclusion: The interrupted closure was not superior to the continuous closure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Female
  • Follow-Up Studies
  • Genital Neoplasms, Female / surgery*
  • Hernia, Ventral / etiology
  • Humans
  • Incidence
  • Laparotomy / adverse effects
  • Middle Aged
  • Risk Factors
  • Surgical Wound Dehiscence / etiology
  • Suture Techniques / economics
  • Suture Techniques / standards*
  • Time Factors
  • Wound Healing