Suture Techniques to Reduce the Incidence of The inCisional Hernia (STITCH)

Sint Franciscus Gasthuis, Vlietland Ziekenhuis, Elisabeth-TweeSteden Ziekenhuis, Meander Medical Center, Kennemer Gasthuis, Rijnstate Hospital, Groene Hart Ziekenhuis, Havenziekenhuis, Red Cross Hospital Beverwijk

The objective of the study is reduction of the incidence of the most frequent complication of abdominal surgery, incisional hernia. In this multi center double-blinded prospective randomized controlled trial, in which a new suture technique using small bites is compared with the traditionally applied large bites (mass closure) technique for midline incisions.

As control the conventional large bites technique (mass closure) will be applied in with bites widths of 1 cm and inter-suture spacing of 1 cm with the use of PDS plus ll 1-0 double loop suture material with a 48 mm needle.

In the other group of 288 patients the small bites technique will be applied with bite widths of 0,5 cm and inter suture spacing of 0,5 cm with the use of PDS plus ll 2-0 single suture material with a 31 mm needle placed in the linea alba. In the small bites technique, twice as many stitches will be placed per sutured cm, with a smaller needle and thinner suture material.

Closure of the midline incision after any abdominal operation. Suturing of the fascia of the abdominal wall with two different techniques

Incisional hernia occurrence within one year after operation clinical and/or radiographically detected

postoperative complications; in particular wound infection (during admission), burst abdomen (during admission) and wound pain (measured with a visual analog scale (VAS) during the first 6 days after surgery).

Inclusion criteria Signed informed consent All laparotomies with a midline incision Age > 18 years Exclusion criteria Previous incisional hernia after midline incision Previous surgery through a midline incision within 3 months Pregnancy (in women)

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