2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7d0,Incisional hernia remains the most common complication of open abdominal surgery. The aim was to investigate whether a reinforced tension-line suture combined with standard 4 : 1 small-bite closure reduces the 3-year incidence of computed tomography-detected incisional hernia in open colorectal cancer surgery. Patients aged > 18 years, scheduled for colorectal cancer resection through a midline incision between 2017 and 2021 at Skåne University Hospital Malmö and Kristianstad County Hospital, Sweden, were eligible for inclusion. Patients were randomized to fascial closure by reinforced tension-line suture combined with 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure alone with polydioxanone sutures (PDS group), in a 1 : 1 ratio. Computed tomography interpreters were blinded to study groups. Univariate, bivariate, and multivariate logistic regression analyses were performed to investigate and adjust study groups for potential risk factors for incisional hernia. The study randomized 80 patients in each group. At 3 years, 101 remained for analysis: 43 in the RTL group and 58 in the PDS group. Incisional hernia was detected in 27 patients: 6 of 43 (14%) in the RTL and 21 of 58 (36%) in the PDS group, resulting in a significant risk difference of 22% (odds ratio 3.50, 95% confidence interval 1.27 to 9.66; P = 0.016). In multivariate analysis, the PDS group (odds ratio 3.40, 1.14 to 10.14; P = 0.028) and adjuvant chemotherapy (odds ratio 2.98, 1.10 to 8.08; P = 0.032) were significant risk factors for incisional hernia. No adverse events related to the closure techniques were found in either group. Adding a reinforced tension-line suture significantly reduced the long-term incidence of incisional hernia compared with the 4 : 1 small-bite technique alone in patients undergoing open colorectal cancer surgery. These findings suggest that the reinforced tension-line suture is an efficient and easy way to prevent incisional hernia.31:Ta53,Abstract Background Incisional hernia remains the most common complication of open abdominal surgery. The aim was to investigate whether a reinforced tension-line suture combined with standard 4 : 1 small-bite closure reduces the 3-year incidence of computed tomography-detected incisional hernia in open colorectal cancer surgery. Methods Patients aged > 18 years, scheduled for colorectal cancer resection through a midline incision between 2017 and 2021 at Skåne University Hospital Malmö and Kristianstad County Hospital, Sweden, were eligible for inclusion. Patients were randomized to fascial closure by reinforced tension-line suture combined with 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure alone with polydioxanone sutures (PDS group), in a 1 : 1 ratio. Computed tomography interpreters were blinded to study groups. Univariate, bivariate, and multivariate logistic regression analyses were performed to investigate and adjust study groups for potential risk factors for incisional hernia. Results The study randomized 80 patients in each group. At 3 years, 101 remained for analysis: 43 in the RTL group and 58 in the PDS group. Incisional hernia was detected in 27 patients: 6 of 43 (14%) in the RTL and 21 of 58 (36%) in the PDS group, resulting in a significant risk difference of 22% (odds ratio 3.50, 95% confidence interval 1.27 to 9.66; P = 0.016). In multivariate analysis, the PDS group (odds ratio 3.40, 1.14 to 10.14; P = 0.028) and adjuvant chemotherapy (odds ratio 2.98, 1.10 to 8.08; P = 0.032) were significant risk factors for incisional hernia. No adverse events related to the closure techniques were found in either group. Conclusion Adding a reinforced tension-line suture significantly reduced the long-term incidence of incisional hernia compared with the 4 : 1 small-bite technique alone in patients undergoing open colorectal cancer surgery. These findings suggest that the reinforced tension-line suture is an efficient and easy way to prevent incisional hernia. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Incisional Hernia: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Incisional Hernia (condition). Clinician-written summaries and actionable practice insights. 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Wide hernias (>20 mm) were nearly halved: 17% vs 34% (HR 0.36, 95% CI 0.21–0.60). Mean hernia width was smaller in the small-bites group (25 mm vs 43 mm, P = .02). Hernia repair rates were similar between groups. Patients with incisional hernia reported significantly lower quality of life.","limitations":"- Long follow-up led to substantial attrition; only 170 patients were alive and hernia-free at final follow-up, and just 72% of those received confirmatory ultrasound.\n- Imaging was available for only 238 patients via routine care, introducing potential ascertainment bias.\n- Single-country (Netherlands) design may limit generalizability to other settings or patient populations.","practice_takeaway":"Small-bites fascial closure durably cuts incisional hernia risk and hernia size over 13 years with no added cost or complexity — surgeons performing midline laparotomy should use it as the default technique. Adoption strategies and broader patient-centered outcome research are still warranted."}},{"doi":"10.1093/bjsopen/zraf150","pmid":"41504702","title":"Reinforced tension-line suture after laparotomy: long-term results of Rein4CeTo1 randomized clinical trial","journal_title":"BJS Open","journal_issn":"2474-9842","published_at":"2026-01-08T00:00:00.000Z","url":"https://doi.org/10.1093/bjsopen/zraf150","source_score":104,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-11","doi":"10.1093/bjsopen/zraf150","days":"14","issn":"2474-9842","rank":"3","field":"Clinical Medicine","score":"104","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1093/bjsopen/zraf150","title":"Reinforced tension-line suture after laparotomy: long-term results of Rein4CeTo1 randomized clinical trial.","journal":"BJS open","methods":"","results":"The study randomized 80 patients in each group. At 3 years, 101 remained for analysis: 43 in the RTL group and 58 in the PDS group. Incisional hernia was detected in 27 patients: 6 of 43 (14%) in the RTL and 21 of 58 (36%) in the PDS group, resulting in a significant risk difference of 22% (odds ratio 3.50, 95% confidence interval 1.27 to 9.66; P = 0.016). In multivariate analysis, the PDS group (odds ratio 3.40, 1.14 to 10.14; P = 0.028) and adjuvant chemotherapy (odds ratio 2.98, 1.10 to 8.08; P = 0.032) were significant risk factors for incisional hernia. No adverse events related to the closure techniques were found in either group.","abstract":"$30","keywords":[],"pubmed_id":"41504702","conclusions":"Adding a reinforced tension-line suture significantly reduced the long-term incidence of incisional hernia compared with the 4 : 1 small-bite technique alone in patients undergoing open colorectal cancer surgery. 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Technique","value_numeric":null},{"paper_doi":"10.1093/bjsopen/zraf150","tag_type":"sample_size","value":"n=160","value_numeric":160},{"paper_doi":"10.1093/bjsopen/zraf150","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1093/bjsopen/zraf150","tag_type":"warning","value":"Different suture materials between groups (polypropylene vs polydioxanone) could influence outcomes independent of technique.","value_numeric":null},{"paper_doi":"10.1093/bjsopen/zraf150","tag_type":"warning","value":"Only 101 of 160 randomized patients had 3-year CT outcomes, and group sizes were unequal at follow-up (43 vs 58).","value_numeric":null},{"paper_doi":"10.1093/bjsopen/zraf150","tag_type":"warning","value":"The abstract does not state whether the primary analysis was intention-to-treat or per-protocol.","value_numeric":null}],"summaries":{"what_studied":"A randomized clinical trial in adults undergoing open colorectal cancer resection via midline incision compared reinforced tension-line suture plus 4:1 small-bite polypropylene closure versus 4:1 small-bite polydioxanone closure alone, assessing CT-detected incisional hernia at 3 years.","key_result":"At 3 years, incisional hernia occurred in 6/43 (14%) with reinforced tension-line closure versus 21/58 (36%) with small-bite alone (risk difference 22%; OR 3.50, 95% CI 1.27–9.66; P=0.016). Multivariate analysis identified assignment to small-bite alone (OR 3.40, 1.14–10.14; P=0.028) and adjuvant chemotherapy (OR 2.98, 1.10–8.08; P=0.032) as risk factors; no closure technique–related adverse events were reported.","limitations":"High attrition with 101 of 160 randomized patients analyzed at 3 years (43 vs 58 per group), raising potential bias. Different suture materials were used between groups (polypropylene versus polydioxanone), which may confound whether effects are due to technique or material.","practice_takeaway":"In open colorectal cancer midline closures, adding a reinforced tension-line suture to small-bite closure lowered 3-year CT-detected incisional hernia from 36% to 14% in this trial, with no technique-related adverse events reported. Apply cautiously given attrition and differing suture materials between groups."}}],"initialOffset":2,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Incisional Hernia"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Incisional Hernia"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Incisional Hernia"}}}]]

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