BURST ABDOMEN AND INCISIONAL HERNIA AFTER MAJOR GASTROINTESTINAL OPERATIONS - COMPARISON OF 3 CLOSURE TECHNIQUES

Objective: To compare the incidence of burst abdomen and incisional he rnia after three different techniques of closure of the abdominal wall after major gastrointestinal operations. Design: Prospective, randomi sed, controlled trial. Setting: University hospital, Norway. Subjects: 599 adults who underwent major operations for gastrointestinal condit ions between December 1990 and February 1992. Interventions: Patients were randomised in three groups for abdominal wall closure by continuo us mass polyglyconate (Maxon) double suture with loop, continuous mass polyglactin 910 (Vicryl), and interrupted polyglactin 910 (Vicryl) (l ayered for transverse and mass for midline incisions). Main outcome me asures: Burst abdomen during the postoperative period, and incisional hernia after one year follow up. Results: The incidence of wound dehis cence was 2% and of incisional hernia at one year 7%. There were no di fferences in the rate of dehiscence among the groups, but there were s ignificantly more hernias in the polyglyconate group (19/164, 12%) com pared with the two in which polyglactin 910 was used (16/327, 5%). Wou nd infections developed in 84/583 of our patients (14%) and the incide nce was closely associated with emergency operations and contamination . Wound complications were not associated with the closure technique. Conclusions: Wound infection is the most important single factor in th e development of burst abdomen and incisional hernia. The continuous c losure technique is quicker, cheaper, and as safe as the interrupted t echnique.