Evidence map›Paper›PMID 38536592›Full record

Trial reportHernia : the journal of hernias and abdominal wall surgery2024

Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial.

R H Fortelny, A Hofmann, P Baumann, S Riedl, J L Kewer, J Hoelderle, A Shamiyeh, B Klugsberger, T D Maier, G Schumacher and 4 more

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter StudyComparative Study
In one paragraph

Trial report in Hernia : the journal of hernias and abdominal wall surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01965249 (Short Stitch Versus Long Stitch Suture Technique Using Monomax® for Abdominal Wall Closure After Primary Median Laparotomy. A Randomized, Controlled, Double-blinded, Multicenter, International Trial), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01965249 nacompletednot on this map

Short Stitch Versus Long Stitch Suture Technique Using Monomax® for Abdominal Wall Closure After Primary Median Laparotomy. A Randomized, Controlled, Double-blinded, Multicenter, International Trial

TypeinterventionalSponsorAesculap AGRan2014 to 2024Enrolled425ConditionsInjury of Abdominal WallArmsLong stitch, Short Stitch
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
  6. Mesh suture repair of rectus diastasis with and without a concurrent ventral hernia.Hernia : the journal of hernias and abdominal wall surgery · 2025
    Article
  7. Variable use of modern abdominal wall closure techniques at emergency laparotomy - an international, cross-sectional survey of surgical practice.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
    Article
  8. Observational
  9. Suture Techniques and Materials for Fascial Closure of Abdominal Wall Incisions: A Comprehensive Meta-Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

R H FortelnyAllgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital Montleartstr. 37, 1160, Vienna, Austria. dr.fortelny@gmail.com.ORCID 0000-0002-0066-7716
A HofmannDepartment of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, 81377, Munich, Germany.
P BaumannDepartment of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz, 78532, Tuttlingen, Germany.
S RiedlAlb Fils Klinik GmbH, Klinik am Eichert, Allgemeinchirurgie, Eichertstr. 3, 73035, Göppingen, Germany.
J L KewerKlinikum Landkreis Tuttlingen, Viszeral- und Gefäßchirurgie, Klinik für Allgemein, Zeppelinstr. 21, 78532, Tuttlingen, Germany.
J HoelderleKlinikum Landkreis Tuttlingen, Viszeral- und Gefäßchirurgie, Klinik für Allgemein, Zeppelinstr. 21, 78532, Tuttlingen, Germany.
A ShamiyehKepler Universitätsklinikum GmbH, Klinik für Allgemein- und Viszeralchirurgie, Krankenhausstr. 9, 4021, Linz, Austria.
B KlugsbergerKepler Universitätsklinikum GmbH, Klinik für Allgemein- und Viszeralchirurgie, Krankenhausstr. 9, 4021, Linz, Austria.
T D MaierRobert-Bosch-Krankenhaus, Allgemein- und Viszeralchirurgie, Auerbachstr. 110, 70376, Stuttgart, Germany.
G SchumacherStädtisches Klinikum Braunschweig, Chirurgische Klinik, Salzdahlumer Str. 90, 38126, Brunswick, Germany.
F KöckerlingVivantes Humboldt-Hospital, Hernia Center, Am Nordgraben 2, 13509, Berlin, Germany.
Ursula PessionZentrum der Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai, 60590, Frankfurt am Main, Germany.
M SchirrenDepartment of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, 81377, Munich, Germany.
M AlbertsmeierDepartment of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, 81377, Munich, Germany.ORCID 0000-0002-5028-5062

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial.

methodsThe ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint.

resultsThe 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112-2.8485]; p = 0.31).

conclusionHernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique. TRIAL REGISTRY: NCT01965249, registered on 18 October 2013.

Indexed as

Abdominal Wound Closure TechniquesElective Surgical ProceduresIncisional HerniaSuture TechniquesAgedDouble-Blind MethodFemaleFollow-Up StudiesHernia, VentralHumansHydroxybutyratesMaleMiddle AgedPolyestersProspective StudiesSuturesHydroxybutyratespoly(4-hydroxybutanoate)PolyestersIncisional herniaLaparotomyPreventionRandomised-controlled trialShort stitchesSmall bites

Identifiers

PMID38536592
PMCPMC11297062

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.