Interrupted X-Suture Prevents Burst Abdomen: Analysis of 5 Randomised Controlled Trials from India

Burst abdomen is a grave complication of laparotomy. X-suturing has been developed as a new method for reducing risk of burst abdomen. Five randomised controlled trials were conducted comparing X-suture with continuous suture in patients undergoing emergency laparotomy. The analysis of pooled data is presented. Data from five randomised controlled trials were collated. Data on individual patients were obtained from each centre on an Excel database format. A total of 1005 patients undergoing emergency laparotomy were studied. Of these 494 patients were randomised to X-suture arm and 511 to the continuous suture arm. The occurrence of burst abdomen was the main outcome of interest and the suture technique the main predictor of burst. The continuous suture group was considered the reference category. Risk ratio, risk difference, attributable proportion in exposed and prevented fraction in the exposed were calculated. Burst abdomen occurred in 9.31% patients in the X-suture group and in 20.35% patients in the continuous suture group. The risk difference (11%) and relative risk = 0.45 were highly significant (p = 0.0001) with a prevented fraction = 54%. Presence of diabetes, intraperitoneal sepsis, uraemia, and raised serum bilirubin were associated with increased risk of burst abdomen. The risk of burst abdomen can be substantially reduced with the use of X-suture in patients undergoing emergency laparotomy.