Page 31 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

mm needle. In the second group, the small bites technique will be applied with bite widths of 0,5 cm and intersuture spacing of 0,5 cm with the use of PDS plus II 2-0 with a 31 mm needle. In the small bites technique, twice as many stitches will be placed per sutured cm, with a smaller needle and thinner suture material. In the Swedish hospital where the small bites techniques has been in use for many years, this combination proved the easiest and safest method to perform the small bites technique(18, 34).
In both groups wound length is measured before closing of the fascia. After measurement of the wound length, the number of stitches is calculated. In the large bites technique at least one suture per cm wound length must be placed. In the small bites technique at least two sutures per cm wound length must be placed. The number of stitches is counted by the assistant during closure.
In both arms, suturing is initiated at both ends of the incision towards the middle where an overlap will be created of at least 2 cm. The remaining sutures will be measured and the suture length used for closure of the fascia and the SL:WL ratio will be calculated by the scrub nurse. In both arms, suture length to wound length ratios (SL:WL) of 4:1 are aimed at.
Implementation
In every hospital the OR nurses the surgeons or gynecologists and residents are instructed before the start of the trial in the individual institution during presentations and demonstration movies. During at least the rst ve inclusions the study coordinator will be present in the OR before randomization to assist randomization and control the correct applying of the standardized techniques. For every included patient a form with the detailed closing protocol in added to the clinical chart. Only when the surgeon is familiar with both the techniques, the nurses with the counting and measuring of the stitches and suture material and the study, centers are allowed to run the trial. Also for every included patient a form with the detailed closing protocol in added to the clinical chart. During the study unplanned audits are performed to control quality.
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STITCH protocol
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