E E Lozada-Hernández1, J C Mayagoitía-González2, R L Smolinski-Kurek3, L Montiel-Hinojosa3, L Hernández-Villegas4, J M Morales-Vargas3, K D Pérez-Sánchez5, A Orozco-Mosqueda3, M Cano-Rosas3. 1. General Surgery, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B Colonia Quinta los Naranjos, Leon Guanajuato, Mexico. edgardlozada@hotmail.com. 2. General Surgery, Medica Campestre Hospital, Leon Guanajuato, Mexico. 3. General Surgery, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B Colonia Quinta los Naranjos, Leon Guanajuato, Mexico. 4. General Surgery, Mexican Social Security Institute, Leon Guanajuato, Mexico. 5. General Practitioner, General Hospital of Guanajuato, Guanajuato, Mexico.
Abstract
PURPOSE: Incisional hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy. METHODS: Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed. RESULTS: A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14-0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. CONCLUSIONS: The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. TRIAL REGISTRATION: Local Committee CI-HRAEB-2013-020. March 13, 2013. CLINICAL TRIALS: NCT02136628, retrospectively registered.
PURPOSE: Incisional hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy. METHODS: Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed. RESULTS: A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14-0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. CONCLUSIONS: The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. TRIAL REGISTRATION: Local Committee CI-HRAEB-2013-020. March 13, 2013. CLINICAL TRIALS: NCT02136628, retrospectively registered.
Authors: C San Miguel; D Melero; E Jiménez; P López; Á Robin; L A Blázquez; J López-Monclús; E González; C Jiménez; M Á García-Ureña Journal: Hernia Date: 2018-10-04 Impact factor: 4.739
Authors: Eva B Deerenberg; Joris J Harlaar; Ewout W Steyerberg; Harold E Lont; Helena C van Doorn; Joos Heisterkamp; Bas Pl Wijnhoven; Willem R Schouten; Huib A Cense; Hein Bac Stockmann; Frits J Berends; F Paul Hlj Dijkhuizen; Roy S Dwarkasing; An P Jairam; Gabrielle H van Ramshorst; Gert-Jan Kleinrensink; Johannes Jeekel; Johan F Lange Journal: Lancet Date: 2015-07-15 Impact factor: 79.321
Authors: Philippe M Glauser; Philippe Brosi; Benjamin Speich; Samuel A Käser; Andres Heigl; Robert Rosenberg; Christoph A Maurer Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: An P Jairam; Lucas Timmermans; Hasan H Eker; Robert E G J M Pierik; David van Klaveren; Ewout W Steyerberg; Reinier Timman; Arie C van der Ham; Imro Dawson; Jan A Charbon; Christoph Schuhmacher; André Mihaljevic; Jakob R Izbicki; Panagiotis Fikatas; Philip Knebel; René H Fortelny; Gert-Jan Kleinrensink; Johan F Lange; Hans J Jeekel Journal: Lancet Date: 2017-06-20 Impact factor: 79.321