Influence of abdominal-wound closure technique on complications after surgery: a randomised study

Background Wound complications that occur after closure of midline laparoto my remain challenging. A new continuous double-loop closure (CDLC) techniqu e was developed to avoid wound rupture through resistance to high intra-abd ominal pressure and continued approximation of wound edges. We investigated the efficacy of this technique. Methods We randomly assigned 390 patients undergoing midline laparotomy-wou nd closure with the commonly used continuous running suture (CRS) technique (n=204) or with the CDLC technique (n=186). We assessed the influence of c losure technique on the rate of wound and other complications, with emphasi s on wound dehiscence, pulmonary complications, and death. Findings The rate of wound complications did not differ significantly betwe en groups. Pulmonary complications were seen in 11 patients (5.4%) in the C RS group, and in 32 patients (17.2%) in the CDLC group (p=0.0002). In the C RS group, 17 (8.3%) patients died, compared with 39 (21.0%) patients in the CDLC group (p=0.0004). Interpretation The CDLC technique should not be used. The lessened complian ce of the abdominal wall,which raises intra-abdominal pressure for long per iods, may increase the risk of postoperative pulmonary complications and de ath. The ideal closure technique should combine strength to prevent wound r upture with elasticity to adapt to increased intra-abdominal pressure.