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This randomized clinical trial assessed whether a reinforced tension-line suture combined with standard 4:1 small-bite fascial closure reduces the 3-year incidence of CT-detected incisional hernia in open colorectal cancer surgery. Adults undergoing midline incision colorectal resection were randomized to RTL plus 4:1 closure or 4:1 closure alone, with blinded CT interpretation and logistic regression adjusting for risk factors. RTL significantly lowered 3-year incidence (14% vs 36%).",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/reinforced-tension-line-suture-after-laparotomy-long-term-results-of-rein4ceto1-randomized-clinical-trial/458513/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/reinforced-tension-line-suture-after-laparotomy-long-term-results-of-rein4ceto1-randomized-clinical-trial/458513.png","ImageObject",300,407,{"name":92,"@type":93},"Cipher","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What question does the study investigate about closure techniques?","Question",{"text":113,"@type":114},"The study investigates whether adding a reinforced tension-line suture to a standard 4:1 small-bite closure reduces the 3-year incidence of CT-detected incisional hernia after open colorectal cancer surgery.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were participants assigned to treatment groups?",{"text":118,"@type":114},"Eligible adults undergoing midline incision colorectal cancer resection were randomized 1:1 to either reinforced tension-line suture plus 4:1 small-bite closure (RTL group) or 4:1 small-bite closure alone using different suture materials.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the key long-term findings at 3 years?",{"text":122,"@type":114},"At 3 years, incisional hernia occurred in 14% of the RTL group versus 36% of the PDS group, producing a significant risk difference; multivariate analysis identified PDS group and adjuvant chemotherapy as significant risk factors.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},458513,1790878886,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46,"preview_page_count":4},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","BJS Open, 2026, zraf150  \n[https://doi.org/10.1093/bjsopen/zraf150](https://doi.org/10.1093/bjsopen/zraf150)  \nRandomized Clinical Trial  \nReinforced tension-line suture after laparotomy:  \nlong-term results of Rein4CeTo1 randomized clinical trial  \nCharlotta L. Wenzelberg1,2 , Peder Rogmark1,2, Olle Ekberg3,4, Ulf Petersson1,2 and Carl-Fredrik Rönnow1,2,*   \n1Department of Clinical Sciences Malmö, Lund University, Lund, Sweden  \n2Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden 3Department of Translational Medicine Malmö, Lund University, Lund, Sweden 4Department of Radiology Diagnostics, Skåne University Hospital Malmö, Malmö, Sweden  \n*Correspondence to: Carl-Fredrik Rönnow, Department of Clinical Sciences, Skåne University Hospital, Jan Waldenströms gata11A, Malmö SE-205 02, Sweden (e-mail: [carl-fredrik.ronnow@med.lu.se](carl-fredrik.ronnow@med.lu.se))  \nAbstract  \nBackground: 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.  \nMethods: 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.  \nResults: 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.  \nConclusion: 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.  \nIntroduction  \nIncisional hernia (IH) constitutes the most common long-term complication associated with open abdominal surgery1–5. The incidence of IH is uncertain, ranging from 0 to 36% in a large meta-analysis6 , but rates have been reported to be as high as 60% in specific high-risk populations3 ,6. Minimally invasive techniques have reduced the proportion of patients undergoing midline laparotomy, but open abdominal surgery will continue to be performed to some extent in the foreseeable future. In addition, minimally invasive techniques often require a restricted midline incision for specimen extraction with anon-negligible risk of IH7.  \nThe clinical presentation and symptoms of IH vary greatly, from absence of symptoms to pain, discomfort, and impaired quality of life, to potentially life-threatening disorders including incarceration and bowel strangulation1 , 5. Besides patient-related outcomes, IH has a substantial economic impact on healthcare costs, estimated to be > $3 billion annually in the USA in 20068 ,9. Consequen","cbCaiuwzMYNeq2fC","https://ap.wps.com/l/cbCaiuwzMYNeq2fC","pdf",273974,"English","# Abstract\n# Background\n# Methods\n# Results\n# Conclusion\n# Introduction","[{\"question\":\"What question does the study investigate about closure techniques?\",\"answer\":\"The study investigates whether adding a reinforced tension-line suture to a standard 4:1 small-bite closure reduces the 3-year incidence of CT-detected incisional hernia after open colorectal cancer surgery.\"},{\"question\":\"How were participants assigned to treatment groups?\",\"answer\":\"Eligible adults undergoing midline incision colorectal cancer resection were randomized 1:1 to either reinforced tension-line suture plus 4:1 small-bite closure (RTL group) or 4:1 small-bite closure alone using different suture materials.\"},{\"question\":\"What were the key long-term findings at 3 years?\",\"answer\":\"At 3 years, incisional hernia occurred in 14% of the RTL group versus 36% of the PDS group, producing a significant risk difference; multivariate analysis identified PDS group and adjuvant chemotherapy as significant risk factors.\"}]","Reinforced tension-line suture after laparotomy - long-term results of Rein4CeTo1 randomized clinical trial | PDF",1790753553]