Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations

Background Severe obesity is cited as a major risk factor for fascial wound dehisence and late incisional hernia after major abdominal surgery. The purpose of this study was to prospectively compare two methods of closure of the linea alba after gastric restrictive operations performed for treatment of morbid obesity. Methods During a 6-year period 229 patients were randomized to have closure of the midline fascia using either a double-stranded #1 PDS suture placed in a continuous fashion or #1 Ethibond suture placed using an interrupted figure-eight technique. Results Two of 109 patients who had closure with Ethibond suffered an acute dehiscence of the midline fascia vs no cases of fascial dehiscence in the PDS group. There were no wound infections in either group. There were 20 late incisional hernias (18%) in the Ethibond group vs 11 late hernias (10%) in the PDS group (P ≤0.04). Mean postoperative follow-up time for all patients was 29.4 months. The cost of suture material and the time required to completely close the linea alba were also calculated for each group. The mean closure time in the Ethibond group was 13.3 vs 9.1 minutes in the PDS group (P<0.0001). Although the cost per suture pack of #1 PDS was $4.63 vs $1.76 per pack for #1 Ethibond, the mean cost of sutures per patient was $4.81 for PDS vs $11.09 for Ethibond. Conclusions We conclude that #1 PDS placed in a continuous fashion provides a more secure and cost-effective closure of the midline fascia in morbidly obese patients than #1 Ethibond placed using an interrupted figure-eight technique.