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

NCT07585344 | Completed

• 2 other identifiers: CRS-2024-135-8238/IMDC/IREB-2025
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective randomized comparative study aims to evaluate whether interrupted figure-of-X fascial closure reduces the incidence of burst abdomen compared with continuous suturing in patients undergoing open colorectal laparotomy. Burst abdomen is a serious postoperative complication associated with increased morbidity, prolonged hospital stay, and reoperation. A total of 40 adult patients undergoing elective or emergency colorectal laparotomy will be randomized into two groups: interrupted figure-of-X closure or continuous fascial closure. The primary outcome will be the incidence of burst abdomen within 30 days after surgery. Secondary outcomes will include surgical site infection, seroma, hematoma, and length of hospital stay. The study is being conducted at the Department of General Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan.

Conditions

Colorectal Cancer

Keywords

colorectal cancer; Figure-of-Eight; surgical wound dehiscence

Outcome Measures

Primary Outcomes (1)

• THE INCIDENCE OF BURST ABDOMEN

  The number of participants experiencing postoperative disruption of the musculo-fascial layer (complete wound dehiscence) following midline laparotomy.

  UPTO 30 DAYS POST SURGERY

Secondary Outcomes (3)

• Incidence of Surgical Site Infection (SSI)

  UPTO 30DAYS POST SURGERY

• Postoperative Seroma and Hematoma Formation

  Up to 30 days post-surgery.

• Length of Hospital Stay

  From date of surgery until date of discharge (approximately 7-14 days).

Study Arms (2)

interrupted figure of X SUTURE

EXPERIMENTAL

Abdominal wall closure performed using the interrupted 'Figure-of-X' suturing technique. The fascia is closed with interrupted X-shaped sutures using a slowly absorbable monofilament (PDS) or similar material. Each suture involves taking 1 cm tissue bites from the fascial edges with approximately 1 cm intervals between each 'X' to ensure secure mass closure.

Procedure: Interrupted 'Figure-of-X' Suturing Technique

CONTINUOUS MASS CLOSURE

ACTIVE COMPARATOR

: Abdominal wall closure performed using the standard continuous (running) suturing technique. A single-layer continuous mass closure is executed using a slowly absorbable monofilament suture material. The technique involves continuous stitching with approximately 1 cm tissue bites and 1 cm intervals between each loop to ensure an even distribution of tension across the midline incision.

Procedure: CONTINUOUS AMSS CLOSURE

Interventions

Interrupted 'Figure-of-X' Suturing Technique PROCEDURE

For the Figure-of-X: Specify the use of a "slowly absorbable monofilament suture" with "1 cm tissue bites and 1 cm spacing" in an interrupted X-pattern. For the Continuous closure: Specify the use of a "single-layer continuous mass closure" with the same suture material and spacing requirements

interrupted figure of X SUTURE

CONTINUOUS AMSS CLOSURE PROCEDURE

The abdominal fascia is closed using a standard single- layer continuous (running) mass closure technique. A slowly absorbable monofilament suture is used to provide prolonged tensile strength. The technique follows a continuous suture line with approximately 1 cm tissue bites from the fascial edges and a 1 cm interval between each loop (travel). The suture is started at one end of the incision and continued to the other, ensuring even tension throughout the length of the midline laparotomy wound.

CONTINUOUS MASS CLOSURE

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

• 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.

Sponsors & Collaborators

• Islamabad Medical and Dental College: lead

Study Sites (1)

Islamabad Medical and Dental College

Islamabad, Punjab Province, 46000, Pakistan

Location

Related Links

• Islamabad Medical and Dental College - Institutional Review Board (IRB) home page.

MeSH Terms

Conditions

Colorectal Neoplasms; Surgical Wound Dehiscence

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, OUTCOMES ASSESSOR
• Masking Details: While the operating surgeons cannot be blinded to the technique used, the ward staff (care providers), the outcomes assessor, and the statistician will remain blinded to the group assignment to minimize bias in wound assessment and data analysis.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomized in a 1:1 ratio to undergo abdominal fascial closure using either interrupted figure-of-X suturing or continuous suturing following colorectal laparotomy. Outcomes will be compared between the two parallel study groups.

Study Record Dates

• First Submitted: May 7, 2026
• First Posted: May 13, 2026
• Study Start: November 7, 2025
• Primary Completion: April 5, 2026
• Study Completion: May 15, 2026
• Last Updated: May 26, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)