Interrupted 'Figure-of-X' Versus Continuous Suturing Technique for Abdominal Wall Closure in Colorectal Laparotomies

Burst abdomen, also known as abdominal wound dehiscence, is a major postoperative complication following midline laparotomy. It is associated with increased postoperative morbidity, prolonged hospitalization, need for reoperation, and increased mortality. Although several abdominal wall closure techniques are currently practiced, the optimal method for preventing fascial dehiscence remains controversial.

Continuous mass closure is commonly used because of its technical simplicity and shorter operative time. However, interrupted techniques, including interrupted figure-of-X suturing, may distribute tension more evenly across the wound and potentially reduce the risk of fascial disruption. Previous randomized and observational studies have shown inconsistent results regarding superiority of one closure technique over another, particularly in high-risk abdominal surgeries.

This study aims to compare interrupted figure-of-X closure with continuous fascial closure in patients undergoing colorectal laparotomy. The study will be conducted as a prospective, randomized, single-center comparative trial at Akbar Niazi Teaching Hospital, Islamabad, Pakistan.

After informed consent and eligibility assessment, 40 adult patients undergoing elective or emergency open colorectal laparotomy will be randomized in a 1:1 ratio into two groups:

Group A: Interrupted figure-of-X fascial closure Group B: Continuous fascial closure

Randomization will be performed using computer-generated permuted blocks with allocation concealment through sealed opaque envelopes. Surgeons cannot be blinded because of the nature of the intervention; however, postoperative outcome assessors and data analysts will remain blinded to group allocation.

The abdominal fascia in both groups will be closed using slowly absorbable monofilament sutures according to a standardized operative protocol. Operative variables including suture material, bite spacing, operative duration, contamination level, and postoperative wound complications will be recorded.

The primary outcome will be incidence of burst abdomen within 30 days following surgery. Secondary outcomes will include surgical site infection, seroma formation, hematoma, reoperation, and postoperative length of hospital stay.

The findings of this study may help determine a safer and more effective abdominal wall closure technique in colorectal laparotomy patients and may contribute to improved postoperative surgical outcomes in high-risk populations.

Inclusion criteria

• Adult patients (aged 18 years and above).
• Patients undergoing open laparotomy for histologically confirmed colorectal cancer.
• Elective surgical procedures.

Exclusion criteria

• Patients with a previous midline laparotomy within the last 30 days.
• Patients in whom the abdominal wall is planned to be left open or managed with a temporary closure (open abdomen).
• Patients with known connective tissue disorders (e.g., Ehlers-Danlos syndrome) that might impair wound healing.
• Patients with an expected survival of less than 30 days.
• Emergency laparotomies.