A RANDOMIZED COMPARISON OF CONTINUOUS VERSUS INTERRUPTED MASS CLOSUREOF MIDLINE INCISIONS IN PATIENTS WITH GYNECOLOGIC CANCER

Objective: To address the incidence of deep wound dehiscence and incis ional hernia formation with two types of mass closure after vertical m idline laparotomy performed in patients with gynecologic cancer. Metho ds: Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. O f the 614 subjects who could be evaluated, 308 underwent a continuous, non-locking closure with looped polyglyconate suture, and 306 were cl osed with interrupted polyglycolic acid according to the Smead-Jones t echnique. Results: Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infec tion (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follo w-up period was 6 months to 3 years. No patient had evidence of chroni c sinus drainage. Thirty-two (10.4%) of the patients who had the conti nuous closure and 45 (14.7%) of those who were closed with the interru pted method had evidence of incisional hernia (P = .14). No hernia dev eloped in any patient with a wound infection. Four (1.3%) hernias afte r the continuous closure and eight (2.6%) after the interrupted closur e required surgical repair because of patient discomfort (P = .38). Co nclusion: The interrupted closure was not superior to the continuous c losure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster. (C) 1997 by The American College of Obstetricians and Gynecologists.