Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial

• Main Authors: Lai, Larry Weng-Hong, Roslani, April Camilla, Yan, Yang-Wai, Bhojwani, Kavita M., Jamaluddin, Mohamad Fadhil Hadi
• Format: Article
• Published: Wiley 2021
• Subjects: RD Surgery
• Online Access: http://eprints.um.edu.my/27845/

Background: Conventional mass closure uses suture-to-wound length ratio of 4:1 ('long stitch', LS). `Short stitch' (SS) has a suture-to-wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post-operative pain after laparotomy closure using LS and SS. Methods: Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post-operative patient-controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi-squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann-Whitney U-test. Results: Eighty-six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient-controlled analgesia morphine usage 24 h post-operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P = 0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P = 0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P = 0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P = 0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference. Conclusion: There were no differences in post-operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome.