Abdominal Wall Dehiscence After Laparotomy Closure in Abdominal Surgery: a Retrospective Observational Study on the Influence of the Suture Used

NCT ID: NCT06501508

Last Updated: 2024-07-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

1900 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-11-22

Study Completion Date

2024-11-22

Brief Summary

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In this retrospective longitudinal observational study we compare the incidence of fascial dehiscence and incisional hernia in patients operated via abdominal wall incision, comparing the barbed suture Stratafix Symmetric to other types of suture during closure of the abdominal wall. In addition, we plan to analize the impact of other risk factors, patient related and patient unrelated, on the incidence of fascial dehiscence.

Detailed Description

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In this retrospective longitudinal observational study we primarily aim to compare the influence of the applied suture type (Stratafix Symmetric versus other suture types) for primary fascial closure in abdominal surgery on the incidence of fascial dehiscence.

Secondary outcomes such as will also be analized. Primary outcomeis the incidence of abdominal wall dehiscence. Secondary outcomes are the impact of the occurrence of abdominal wall dehiscence on mortality and hospital stay, the influence of other risk factors on the occurrence of abdominal wall dehiscence, the influence of the suture type and other risk factors on the incidence of incisional hernia after 12 months of follow-up and a speciality subgroup analysis.

The diagnoses of each patient and the procedures performed are coded according to ICD 9 or ICD 10. For primary cause diagnoses and secondary diagnoses, external causes and procedures, ICD9/ICD10 codes are also used. Following the AHQR definition, cases of laparotomy dehiscence will be defined as those whose ICD 9/ICD 10 codes conform to "New closure of postoperative abdominal wall disruption", as well as those identified secondarily after crossing the databases as reoperated for this reason with another coding.

Statistical analysis will be performed using statistical techniques appropriate to the variables under study. A descriptive analysis of the population will be performed, frequency results will be expressed in absolute terms, such as percentages and confidence intervals. The percentage of subjects with dehiscence will be calculated by the group. A two-sided 95% confidence interval (CI) for the difference in percentages (Stratafix - Control) will be estimated using the Wald method. If the upper limit of the confidence interval for the difference in percentages (Stratafix-Control) is below 0, then it will be concluded that the true dehiscence rate for Stratafix is lower than that for the control. In addition, two-sided 95% CIs within each group will be estimated for the dehiscence rate using the Clopper-Pearson method.

Continuous variables will be expressed as mean (SD) and median (range) according to the normality test (Kolmogorov Smirnov test). For the study of the relationship between the different variables, Chi-square or Analysis of Variance will be used if they are parametric. And if they do not follow a normal distribution, nonparametric tests will be used (Mann-Whitney U or Kruskal Wallis, as appropriate). Biochemical recurrence-free survival (BCR-free survival) will be estimated using Kaplan-Meier curves. SPSS. 21 (SPSS Inc. Chicago, IL, USA) will be used.

Conditions

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Surgical Wound Dehiscence

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Stratafix

All patients in which Stratafix symmetric was used for the primary closure of the abdominal wall incision

Stratafix Symmetric

Intervention Type DEVICE

Use of Stratafix Symmetric for primary fascial closure

Control

All patients in which other, conventional suture types were used for primary closure of the abdominal wall incision

No interventions assigned to this group

Interventions

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Stratafix Symmetric

Use of Stratafix Symmetric for primary fascial closure

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age over 18 years, abdominal incision or laparoscopy with extraction site incision

Exclusion Criteria

* Pregnancy, use of mesh for fascial closure in primary surgery, history of ventral abdominal hernia surgery
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ethicon, Inc.

INDUSTRY

Sponsor Role collaborator

Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hector Gauadalajara Labajo, PHD

Role: PRINCIPAL_INVESTIGATOR

Quironsalud

Locations

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Hospital universitario General de Villalba

Collado Villalba, Madrid, Spain

Site Status RECRUITING

Hospital Universitario Infanta Elena

Valdemoro, Madrid, Spain

Site Status RECRUITING

Hospital Universitario Fundación Jiménez Díaz

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario Rey Juan Carlos

Madrid, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Hector Gauadalajara Labajo, PHD

Role: CONTACT

0034649429243

Marius Kaser, Dr.

Role: CONTACT

0034652174951

Facility Contacts

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Hector Guadalajara Labajo

Role: primary

0034649429243

Hecotr Guadalajara Labajo

Role: primary

Hector Guadalajara Labajo

Role: primary

0034694429243

Marius Kaeser

Role: backup

0034652174951

Hector Guadalajara

Role: primary

0034649429243

References

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Zolin SJ, Rosen MJ. Failure of Abdominal Wall Closure: Prevention and Management. Surg Clin North Am. 2021 Oct;101(5):875-888. doi: 10.1016/j.suc.2021.07.001.

Reference Type BACKGROUND
PMID: 34537149 (View on PubMed)

Rodriguez-Hermosa JI, Codina-Cazador A, Ruiz B, Roig J, Girones J, Pujadas M, Pont J, Aldeguer X, Acero D. [Risk factors for acute abdominal wall dehiscence after laparotomy in adults]. Cir Esp. 2005 May;77(5):280-6. doi: 10.1016/s0009-739x(05)70854-x. Spanish.

Reference Type BACKGROUND
PMID: 16420934 (View on PubMed)

Gili-Ortiz E, Gonzalez-Guerrero R, Bejar-Prado L, Ramirez-Ramirez G, Lopez-Mendez J. [Postoperative dehiscence of the abdominal wound and its impact on excess mortality, hospital stay and costs]. Cir Esp. 2015 Aug-Sep;93(7):444-9. doi: 10.1016/j.ciresp.2015.02.005. Epub 2015 May 6. Spanish.

Reference Type BACKGROUND
PMID: 25956459 (View on PubMed)

Jensen KK, Oma E, van Ramshorst GH, Nordholm-Carstensen A, Krarup PM. Abdominal wound dehiscence is dangerous: a nationwide study of 14,169 patients undergoing elective open resection for colonic cancer. Hernia. 2022 Feb;26(1):75-86. doi: 10.1007/s10029-020-02350-z. Epub 2021 Jan 4.

Reference Type BACKGROUND
PMID: 33394254 (View on PubMed)

Farquhar M. AHRQ Quality Indicators. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 45. Available from http://www.ncbi.nlm.nih.gov/books/NBK2664/

Reference Type BACKGROUND
PMID: 21328764 (View on PubMed)

Zucker BE, Simillis C, Tekkis P, Kontovounisios C. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis. Ann R Coll Surg Engl. 2019 Mar;101(3):150-161. doi: 10.1308/rcsann.2018.0170. Epub 2018 Oct 5.

Reference Type BACKGROUND
PMID: 30286645 (View on PubMed)

Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976 Nov;63(11):873-6. doi: 10.1002/bjs.1800631110.

Reference Type BACKGROUND
PMID: 137024 (View on PubMed)

Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review. World J Surg. 2018 Jun;42(6):1666-1678. doi: 10.1007/s00268-017-4393-9.

Reference Type BACKGROUND
PMID: 29322212 (View on PubMed)

Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database Syst Rev. 2017 Nov 3;11(11):CD005661. doi: 10.1002/14651858.CD005661.pub2.

Reference Type BACKGROUND
PMID: 29099149 (View on PubMed)

Cengiz Y, Blomquist P, Israelsson LA. Small tissue bites and wound strength: an experimental study. Arch Surg. 2001 Mar;136(3):272-5. doi: 10.1001/archsurg.136.3.272.

Reference Type BACKGROUND
PMID: 11231844 (View on PubMed)

Fortelny RH. Abdominal Wall Closure in Elective Midline Laparotomy: The Current Recommendations. Front Surg. 2018 May 23;5:34. doi: 10.3389/fsurg.2018.00034. eCollection 2018.

Reference Type BACKGROUND
PMID: 29876355 (View on PubMed)

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F; European Hernia Society. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015 Feb;19(1):1-24. doi: 10.1007/s10029-014-1342-5. Epub 2015 Jan 25.

Reference Type BACKGROUND
PMID: 25618025 (View on PubMed)

Tolstrup MB, Watt SK, Gogenur I. Reduced Rate of Dehiscence After Implementation of a Standardized Fascial Closure Technique in Patients Undergoing Emergency Laparotomy. Ann Surg. 2017 Apr;265(4):821-826. doi: 10.1097/SLA.0000000000001762.

Reference Type BACKGROUND
PMID: 28267697 (View on PubMed)

Denys A, Monbailliu T, Allaeys M, Berrevoet F, van Ramshorst GH. Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia. 2021 Apr;25(2):449-462. doi: 10.1007/s10029-020-02294-4. Epub 2020 Sep 8.

Reference Type BACKGROUND
PMID: 32897452 (View on PubMed)

Pereira Rodriguez JA, Amador-Gil S, Bravo-Salva A, Montcusi-Ventura B, Sancho-Insenser JJ, Pera-Roman M, Lopez-Cano M. Small bites technique for midline laparotomy closure: From theory to practice: Still a long way to go. Surgery. 2021 Jul;170(1):140-145. doi: 10.1016/j.surg.2020.12.007. Epub 2021 Jan 15.

Reference Type BACKGROUND
PMID: 33455821 (View on PubMed)

Other Identifiers

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PIC089-23_FJD

Identifier Type: -

Identifier Source: org_study_id

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