Clinical study of "double diabolo" vs. continuous suture for laparotomy closure

Abstract

Background and Objectives: Incisional hernia is a common complication after abdominal surgery and presents a significant challenge for digestive surgeons. In 2000, we proposed a new suture design, termed “double diabolo”, which has optimum physical characteristics to ensure that both the thread and the holes are subjected to the least possible tension. We have since tested its effectiveness in theoretical and experimental studies. In the present paper, we demonstrate the effectiveness of this suture at the clinical level. Methods: A study was conducted on 100 patients all requiring a laparotomy. The operation was performed by the same surgeon for every case. Two study groups were compared: group A with 50 patients for whom the laparotomy closure was achieved by continuous suture; and group B with 50 patients for whom the laparotomy closure was achieved by double diabolo suture. The following parameters were assessed: age, sex, American Society of Anesthesiologists classification, laparotomy size, postoperative (PO) evisceration, PO wound infection, PO hernia, urgent/scheduled surgery, PO hernia duration, PO complications, and follow-up time. Results: The double diabolo suture group showed a statistically significant reduction in postoperative infections (16% vs. 38%, P = 0.002) and a non-statistically significant trend toward reducing postoperative hernias (14% vs. 28%, P = 0.14). However, the conclusion regarding “reducing the number of hernias” is unsupported by the results, as statistical significance was not achieved for this outcome.
Conclusion: The double diabolo suture reduces the rate of infection in surgical wounds following laparotomy closure and possibly reduces the number of postoperative hernias, although a statistically significant demonstration of the latter outcome requires further study, with a larger number of patients.