From the Guidelines
Stratafix threads left inside the abdomen after surgery generally do not require removal unless they are causing symptoms. These threads are absorbable sutures designed to eventually break down in the body over time, though this process can take several months to years depending on the specific type used 1. If a patient is experiencing symptoms such as pain, infection, or inflammation that may be related to retained suture material, medical evaluation is recommended.
Key Considerations
- The primary goal in managing patients with open abdomen is to achieve rapid closure with the assistance of negative pressure therapy to prevent severe morbidity such as fistulae, loss of domain, and massive incisional hernias 1.
- Early definitive closure (within 4–7 days of the initial laparostomy) is the basis of preventing or reducing the risk of complications 1.
- In asymptomatic patients, watchful waiting is appropriate as the body will typically form scar tissue around the foreign material, isolating it from surrounding structures.
Management Approach
- Surgeons intentionally leave sutures in place after procedures, and complications from retained suture material are uncommon.
- However, if symptoms persist or worsen, imaging studies such as ultrasound or CT scan may be necessary to evaluate the area, and in rare cases where the suture material is causing significant problems, surgical removal might be considered.
- A systematic review and meta-analysis published in 2014 confirmed the clinical advantages of early fascial closure compared with delayed closure in treatment of patients with open abdomen 1.
- The use of negative pressure therapy (NPT) with continuous fascial traction has shown the best results in terms of achieving delayed fascial closure and reducing the risk of entero-atmospheric fistula 1.
From the Research
Remaining Stratafix Thread Intra-Abdomen
- The use of Stratafix Symmetric PDS Plus for abdominal fascial closure in DIEP flap breast reconstruction has been shown to lead to low rates of abdominal donor site morbidity, including no hernia and rare bulging 2.
- There is no direct evidence on the effects of remaining Stratafix thread intra-abdomen, but studies have investigated the use of absorbable sutures in abdominal surgery and their impact on surgical site infections (SSIs) 3, 4.
- The type of intra-abdominal suturing, including absorbable materials like polyglactin (Vicryl), has been found to affect SSI rates in colorectal surgery, with absorbable sutures potentially reducing the risk of SSI 4.
- Other factors, such as antibiotic prophylaxis and mechanical bowel preparation, have also been shown to play a crucial role in reducing SSI rates in colorectal surgery 3, 5.
- A study on the use of Triclosan-coated barbed sutures, including STRATAFIX Symmetric, for wound closure in high-tension areas found low cumulative incidences of 30-day internal wound dehiscence and surgical site infection 6.