The Efficacy and Security of the Small Stitch Technique in Emergency Surgery (STCU)
Abdominal Wall Defect, Abdominal Wall Hernia, Eventration
About this trial
This is an interventional prevention trial for Abdominal Wall Defect
Eligibility Criteria
Inclusion Criteria:
- Patients over 18 years of age and who provide informed consent to participate in the study.
- Patients requiring an urgent midline laparotomy with a minimum size of 8 cm.
Exclusion Criteria:
- Prior midline laparotomy.
- Patients with BMI> 45 kg / m2
- Patients with ASA (American Society of Anesthesiologists)> IV.
- Patient with an advanced terminal illness with an expectation of life <1 year.
- Patients with abdominal aortic aneurysm.
- Patients with coagulopathy: patient previously diagnosed with von Willebrand disease, hemophilia or Immune thrombocytopenic purpura.
- Immunosuppressed patient: HIV patients in the AIDS phase, chronic corticosteroid or immunosuppressive treatment.
- Patients with collagen pathology: patient previously diagnosed with Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria and scleroderma.
- Chemotherapeutic treatment 2 weeks before surgery.
- Radiotherapy treatment 6 weeks before surgery.
- Diffuse peritonitis with hemodynamic instability, defined by non-response to fluids prior to surgery or during the surgical process.
- Pregnant or potentially fertile women, breastfeeding, or intention to become pregnant, or those who do not wish to use effective contraception (hormonal contraceptives (implantation, patches, oral), and double barrier methods (any double combination of: IUD (intrauterine device), male or female prophylactics with spermicidal gel, diaphragm, contraceptive sponge, cervical cap).
Sites / Locations
- Hospital Universitario Virgen Del RocioRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Small Stitch
Large Stitch
Patients requiring an urgent emergency laparotomy. The Small Stitch closure technique will be perform using a Monomax® 2/0 HR26 (Half-circle Round body): It will be use a very long-term monofilament absorbable synthetic suture of Poly-4-hydroxybutyrate (Monomax) 2/0 with HR 26 needle (Half-circle Round body). In the technique should be given at least 2 points for each wound cm, with a distance to the alba line of 0'5cm and 0'5 cm of separation between stitches. The closure starts from both ends, ending in the middle of the laparotomy with an overlap of at least 2 cm. The ratio between the length of the suture and the length of the wound should be at least 4:1.
The intervention will be the classic large Stitch closure technique using a Monomax® 1 HR48 (Half-circle Round body). It will be use a very long-term monofilament absorbable synthetic suture of Poly-4-hydroxybutyrate (Monomax) 1 with HR 48 needle (Half-circle Round body). In the technique should be given 1 point for each wound cm, with a distance to the alba line of 1 cm and 1 cm of separation between stitches. The closure starts from both ends, ending in the middle of the laparotomy with an overlap of at least 2 cm. The ratio between the length of the suture and the length of the wound should be at least 4:1.