CLOSE Trial - The Effect of Closure Technique on Incisional Hernia from Emergency Laparotomy: Small vs Large Bites Evaluation

The intervention is the method used to close the abdominal fascia (the strong layer of tissue in the abdominal wall) at the end of an emergency laparotomy. Participants are randomly assigned to one of two standard techniques: Intervention: - Small-bites closure: Using 2-0 PDS sutures placed 5 mm from the fascial edge and 5 mm apart. In this study, the small-bites closure is considered the intervention. The intervention is delivered by the operating surgeon performing the emergency laparotomy. All participating surgeons are qualified medical practitioners (MBBS, FRACS) working in emergency surgical services at the participating hospitals. The intervention is delivered intraoperatively (during surgery) in the operating theatre. It is an individual, one-time procedure performed on each participant during their emergency laparotomy. Adherence to the assigned closure technique is monitored through: - Randomisation via REDCap: Study staff access the REDCap database approximately 15 minutes before fascial closure to determine the allocated technique, which is then communicated to the operating surgeon. - Data recording: The operating team records the length of the wound, number of sutures used, and time taken to close the fascia, allowing verification that the correct technique was applied. - Stratified randomisation: Randomisation is stratified by study site to minimise variation related to site-specific surgical practice or surgeon skill. Small bites and large bites instruction Small Bites: 2-0 PDS (needle size) with 5mm between bites and from fascial edge. Not to include muscle or fat into the closure. This may mean having to clear the suprafascial fat from fascia. Each suture should be separately knotted with an Aberdeen’s knot – NOT TOGETHER. Include length of wound and number of sutures used. Include time taken to close fascia.