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

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...

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Main Authors: Lai, Larry Weng-Hong, Roslani, April Camilla, Yan, Yang-Wai, Bhojwani, Kavita M., Jamaluddin, Mohamad Fadhil Hadi
Format: Article
Published: Wiley 2021
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RD Surgery
Online Access:http://eprints.um.edu.my/27845/
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spelling my.um.eprints.278452022-04-04T04:42:42Z http://eprints.um.edu.my/27845/ Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial Lai, Larry Weng-Hong Roslani, April Camilla Yan, Yang-Wai Bhojwani, Kavita M. Jamaluddin, Mohamad Fadhil Hadi RD Surgery 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. Wiley 2021-05 Article PeerReviewed Lai, Larry Weng-Hong and Roslani, April Camilla and Yan, Yang-Wai and Bhojwani, Kavita M. and Jamaluddin, Mohamad Fadhil Hadi (2021) Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial. ANZ Journal of Surgery, 91 (5). pp. 896-901. ISSN 1445-2197, DOI https://doi.org/10.1111/ans.16567 <https://doi.org/10.1111/ans.16567>. 10.1111/ans.16567
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic RD Surgery
spellingShingle RD Surgery
Lai, Larry Weng-Hong
Roslani, April Camilla
Yan, Yang-Wai
Bhojwani, Kavita M.
Jamaluddin, Mohamad Fadhil Hadi
Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
description 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.
format Article
author Lai, Larry Weng-Hong
Roslani, April Camilla
Yan, Yang-Wai
Bhojwani, Kavita M.
Jamaluddin, Mohamad Fadhil Hadi
author_facet Lai, Larry Weng-Hong
Roslani, April Camilla
Yan, Yang-Wai
Bhojwani, Kavita M.
Jamaluddin, Mohamad Fadhil Hadi
author_sort Lai, Larry Weng-Hong
title Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
title_short Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
title_full Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
title_fullStr Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
title_full_unstemmed Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: A double-blind randomized controlled trial
title_sort comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: a double-blind randomized controlled trial
publisher Wiley
publishDate 2021
url http://eprints.um.edu.my/27845/
_version_ 1735409529813729280
score 13.244404

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