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Single- vs multiple-layer wound closure for flank incisions: results of a prospective, randomised, double-blinded multicentre study

Objective To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficial-layer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. Patients and...

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Main Authors: Kriegmair, Maximilian (Author) , Younsi, Nina (Author) , Hiller, Kiriaki (Author) , Leitsmann, Conrad (Author) , Kowalewski, Karl-Friedrich (Author) , Siegel, Fabian (Author) , Rothamel, Martin (Author) , Ritter, Manuel (Author) , Bolenz, Christian (Author) , Kriegmair, Martin (Author) , Trojan, Lutz (Author) , Michel, Maurice Stephan (Author)
Format: Article (Journal)
Language:English
Published: 2021
In: BJU international
Year: 2021, Volume: 127, Issue: 1, Pages: 64-70
ISSN:1464-410X
DOI:https://doi.org/10.1111/bju.15148
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/https://doi.org/10.1111/bju.15148
Verlag, lizenzpflichtig, Volltext: https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/bju.15148
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Author Notes:Maximilian C. Kriegmair, Nina Younsi, Kiriaki Hiller, Conrad Leitsmann, Karl F. Kowalewski, Fabian Siegel, Martin Rothamel, Manuel Ritter, Christian Bolenz, Martin Kriegmair, Lutz Trojan and Maurice S. Michel
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Summary:Objective To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficial-layer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. Patients and Methods The study was a randomised controlled, patient- and assessor-blinded, multicentre trial. Between May 2015 and February 2017, 225 patients undergoing flank incisions were randomised 1:1 to a multiple-layer closure (SIMULAC-I) or a single superficial-layer closure (SIMULAC-II) group. The primary outcome was the occurrence of a flank bulge 6 months after surgery. Results Overall, 177 patients (90 in SIMULAC-I, 87 in SIMULAC-II) were eligible for final assessment. The cumulative incidence of a flank bulge was significantly higher in the SIMULAC-II group (51.7%) compared to the SIMULAC-I group [34.4%; odds ratio (OR) 2.04, 95% confidence interval (CI) 1.11-3.73; P = 0.02]. Rate of severe postoperative complications (4.4% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.21) or hernia (6.7% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.59) was similar between the groups. There was no difference in pain (visual analogue scale) and the requirement for pain medication at 6 months postoperatively. Quality of life assessed with the European Quality of Life 5 Dimensions Questionnaire was higher in the SIMULAC-I group compared to the SIMULAC-II group at 6 months postoperatively, with a (median range) score of 80 (30-100) vs 75 (5-100) (P = 0.012). Conclusion The overall risk of a flank bulge after flank incision is high. Multiple-layer closure after flank incision should be performed as a standard procedure.
Item Description:First published: 21 June 2020
Gesehen am 18.05.2021
Physical Description:Online Resource
ISSN:1464-410X
DOI:https://doi.org/10.1111/bju.15148

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