The safety and efficacy of subcutaneous negative pressure drainage to close midline epigastric incision: a retrospective case-control study

The safety and efficacy of subcutaneous negative pressure drainage to close midline epigastric incision: a retrospective case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The safety and efficacy of subcutaneous negative pressure drainage to close midline epigastric incision: a retrospective case-control study Xie Yuan, rui xu, chao Yang, shuo-meng Xiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3862909/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Incision complications were still a problem of open gastrectomy. Aim of this study was to assess the safety and efficacy of a method of closing incision, named subcutaneous negative pressure drainage. Methods A retrospective case-control study was designed to compare the safety and efficacy between subcutaneous suture and subcutaneous negative pressure drainage to close the midline epigastric incision. Clinical data of all the patients underwent open gastrectomy were collected. Characteristics of patients and incision complications were analyzed. Results From January 2015 to July 2023, 430 patients underwent subcutaneous suture and 456 patients underwent subcutaneous negative pressure drainage were included. There were not significantly differences between two groups in clinical characteristics. The rates of surgical site infection and non-infection complications were lower in the subcutaneous negative pressure drainage group. Conclusion Subcutaneous negative pressure drainage was safe and efficient. This approach should be recommended for closure of midline incision. Biological sciences/Cancer Health sciences/Diseases subcutaneous drainage incision closure open gastrectomy Figures Figure 1 Figure 2 Figure 3 Background Surgery was still the mainstay of treatment for gastric cancer. Although laparoscopy gastrectomy developed and used in early gastric cancer in recent years, open gastrectomy still was the classic procedure, especially for advanced gastric cancer[ 1 ]. The midline celiotomy was the most common procedure for open gastrectomy. The incidence of incision problem was 0.6 to 2.0%[ 2 , 3 ]. These incision problems included surgical site infection (SSI), fat liquefaction, fluid accumulation and subcutaneous seroma formation[ 4 ]. These problems were easily treated, but prolonged hospital stay, increased the anxiety and reduced confidence, especially for cancer patients. Effective incision closure may enhance recovery and improve clinical outcomes. We learned at surgical school that in order to prevent dead space, the subcutaneous tissue must be closed precisely. The accumulation of serous fluid and necrotic tissue in the dead space would result in issues with the wound. A method named non-sutured subcutaneous fat tissue was mentioned in an abdominal surgery study[ 5 ]. But this non-sutured method did not reduce the rate of complications. In this study, we replaced subcutaneous suture with a subcutaneous negative pressure drainage. The aim of this study was to compare the safety and efficacy of conventional subcutaneous suture and subcutaneous negative pressure drainage. Methods The study adhered to the Declaration of Helsinki. Individual informed consent was waived as this study was a retrospective analysis ,ethical approval was obtained from the ethics committee of Sichuan cancer hospital.(Approval No. SCCHEC-02-2018-048).All methods were carried out in accordance with relevant guidelines and regulations. All patients enrolled in the study were diagnosed with gastric cancer and underwent open gastrectomy. Preoperative radiotherapy patients and those patients who had underwent middle laparotomy were excluded. Characteristics of patients and incision complications were collected. The Clavien-Dindo classification system was used to assess incision complications[ 6 ]. Subcutaneous negative pressure drainage group Antibiotics was injected before skin incision half an hour and every 3 hours during surgery. After closure of linea alba had completed, saline solution was utilized to wash the subcutaneous tissue. Effective hemostasis was performed. Perforated silicone subcutaneous drainage tube with 14 F diameter was placed under the skin and the skin was sutured by the skin stapler (Fig. 1 – 2 ). After the skin was sutured, the drainage tube was connected to a negative pressure bulb (Fig. 3 ). When the daily drainage amount was less than 1 milliliter over a period of 24 hours, the subcutaneous drainage tube was removed. The skin stapler was typically extracted on the tenth day following surgery. Subcutaneous interrupted suture group Antibiotics was injected before skin incision half an hour and every 3 hours during surgery. The subcutaneous tissue was cleaned with a saline solution following the completion of the closure of the linea alba. The subcutaneous tissue was closed with an interrupted 3 − 0 Vicryl suture to effectively establish hemostasis. In a similar manner, the skin stapler sutured the skin. Usually, the skin stapler was removed ten days after the procedure. Statistical analysis The statistical analysis was conducted using SPSS Statistics 26. For numerical value, Student's t test and the mean difference (MD) with 95% confidence interval (CI) were used to assess the outcomes. For classified value, the x 2 test or Fisher’s exact test were used. A value of P < 0.05 was considered statistically significant. Results From January 2015 to August 2016, four hundred and thirty patients undergoing gastrectomy with subcutaneous suture were included in our analysis. From September 2016 to July 2023, four hundred and fifty-six patients undergoing gastrectomy with subcutaneous negative pressure drainage were included. Characteristics of patients were detailed in Table 1 . For all patients, nutrition screening was performed with Patient-Generated Subjective Global Assessment (PG-SGA) at the time of admission. In two groups, there were not significant differences in terms of PG-SGA, body mass index, hemoglobin, total protein and operation type. Table 1 Clinical Characteristics of Patients Subcutaneous suture (n = 430) Subcutaneous drainage (n = 456) P value Age(years) 59.7 ± 10.4 59.1 ± 11.2 0.37 Sex 0.39 male 314 321 female 116 135 Diabetes mellitus 0.24 Yes 18 27 No 412 429 Body mass index (m 2 /kg) 23.1 ± 3.2 23.4 ± 3.1 0.32 PG-SGA 6.48 ± 4.3 6.84 ± 4.4 0.23 Value:1–3 133 131 Value:4–8 180 185 Value: ≥9 117 140 Hemoglobin 121.01 ± 23.0 120.3 ± 26.3 0.69 Total protein 64.9 ± 5.5 65.4 ± 5.6 0.32 Operation type 0.69 Total gastrectomy 177 200 Proximal gastrectomy 37 35 Distal gastrectomy 216 221 Operation time 208.4 ± 52.6 204.8 ± 55.2 0.32 PG-SGA: Generated Subjective Global Assessment Totally, incision problem was found in nineteen patients in the subcutaneous suture group and in 2 patients in the subcutaneous negative pressure drainage group. All complication was classified as Clavien-Dindo grade ≤ II (Table 2 ). In subcutaneous suture group, the rate of infection was 1.86% (8/430). In the subcutaneous negative pressure drainage group, it was 0.22% (1/456). This rate was significantly lower in the subcutaneous negative pressure drainage group than that in the subcutaneous suture group( P = 0.015). No patient with fat liquefaction or fluid accumulation was found in the subcutaneous negative pressure drainage group. Fat liquefaction was found in six patients and fluid accumulation was found in five patients in the subcutaneous suture group. There were significantly differences between the two groups in terms of fat liquefaction ( P = 0.013) and fluid accumulation ( P = 0.027). In the subcutaneous group, bleeding was found in a patient after pulling out the drainage tube. Hemostasis by compression was performed and reoperation was avoided. In general, the rate of non-infection complications was also lower in the subcutaneous negative pressure drainage group ( P = 0.003). Table 2 Complications of incision Complications Subcutaneous suture (n = 430) Subcutaneous drainage (n = 456) P value Clavien-Dindo classification grade ≤ II Surgical site infection 8 1 0.015 Non infection complications 11 1 0.003 fat liquefaction 6 0 0.013 fluid accumulation 5 0 0.027 bleeding 0 1 1.0 Total 19 2 0.000 Discussion This study assessed two methods of subcutaneous tissue closure for gastric cancer patients undergoing open gastrectomy. These results showed that the rates of incision problems were lower in the subcutaneous drainage group than in the conventional subcutaneous suture group. These results would change clinical decision. The classical surgical procedure of midline incision closure is suturing of subcutaneous tissue. This type of procedure was considered as a method to close dead space and decrease incision complications[ 5 , 7 ]. Fragile tissue and fluid would deposit under the skin regardless of whether a continuous or interrupted suture technique was used. These additional materials could increase the risk of wound complications. Although most of incision problems were classified as Clavien-Dindo grade ≤ II, they would prolong hospital stay, increase the anxiety and reduce confidence. This technique involved the use of a drainage tube that was placed between the linea alba and the skin. The tube was connected to a negative pressure ball and maintained negative pressure. As a result, delicate tissue and fluid were successfully drained. This approach reduced liquid collection and seroma formation. In case of these conditions, caused SSI[ 8 ]. All incisions were vertical in these patients enrolled in this study. The peritoneum and fascia layer were closed as a layer using an interrupted technique. This interrupted suture has the same incidence of incision problems compared to the continuous suture[ 9 ]. In conventional group, interrupted suture was used to close subcutaneous tissue. In trial group, no suture procedure was used. Previous studies showed that the depth of subcutaneous tissue, obesity, increased age, diabetes mellitus and immunosuppression were risk factors for incision complications[ 10 – 13 ]. Soper showed that the depth of subcutaneous tissue was the only significant risk factor for incision infection[ 11 ]. So, closure of subcutaneous tissue was an important procedure to prevent infection. Subcutaneous negative pressure drainage procedure had been used in gynecologic surgery[ 14 – 16 ]. These studies revealed this procedure was safe and effective for women patients. We firstly performed this procedure for elective epigastric surgery and got the same outcomes. This method could drain serous fluid and necrotic tissue out. Compared to the conventional interrupted suture, subcutaneous negative pressure drainage reduced the subcutaneous deposition and the rate of wound complications, and enhanced patient recovery. It would be a procedure of enhanced recovery after surgery. This study has some limits. Firstly, this was a retrospective study. To confirm these results, a prospective random study is needed in the future. Secondly, these enrolled patients only underwent open gastrectomy. For those patients who underwent the other epigastric surgery, it was unclear if this procedure was suitable. Conclusion Subcutaneous negative pressure drainage was safe and efficient. We suggested an application of a subcutaneous negative pressure drainage approach for open gastrectomy. Abbreviations SSI: Surgical Site Infection PG-SGA: Patient-Generated Subjective Global Assessment Declarations Author Contribution Yuan Xie: write this manuscript, collect dataRui Xu:collect data and analysisChao Yang:collect data and analysisShuo-meng: Design, analysis and write Consent for publication Consent for the publication of images of participant. Availability of data and material All data generated or analysed during this study are included in this published article . Competing interests All authors declared that they have no competing interests. Funding There was no funding source for this study. Acknowledgements We give a thanks to all these patients enrolled in this study. References Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 20(1):1–19. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X: Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology :JCO.2015.2063.7215. Terashima M, Iwasaki Y, Mizusawa J, Katayama H, Nakamura K, Katai H, Yoshikawa T, Ito Y, Kaji M, Kimura Y: Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer, the short-term safety and surgical results: Japan Clinical Oncology Group Study (JCOG0501). Gastric Cancer . Ouldamer L, Bonastre J, Brunet-Houdard S, Body G, Giraudeau B, Giraudeau B, Caille A, Caille A: Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. Bmj Open 2016, 6(4):-. Paral J, Ferko A, Varga J, Antos F, Plodr M, Lochman P, Subrt Z: Comparison of Sutured versus Non-Sutured Subcutaneous Fat Tissue in Abdominal Surgery. European Surgical Research, 39(6):350–358. Dindo D: The Clavien–Dindo Classification of Surgical Complications: Springer London; 2014. Kore S, Vyavaharkar M, Akolekar R, Toke A, Ambiye V: Comparison of Closure of Subcutaneous Tissue Versus Non-closure in Relation to Wound Disruption After Abdominal Hysterectomy in Obese Patients. 2000, 46(1):26–28. Marcos S, Rodwan H, Katarina A, Cesar RFP, Renato Z, Milan J: Use of Quilting Sutures During Abdominoplasty to Prevent Seroma Formation: Are They Really Effective? Aesthetic Surgery Journal 2015(5):5. Richards PC, BALCH CM, ALDRETE JS: A Randomized Prospective Study of 571 Patients Comparing Continuous vs. Interrupted Suture Techniques. Annals of Surgery, 197(2):238–243. Tipton AM, Cohen SA, Chelmow D: Wound Infection in the Obese Pregnant Woman. 35(6):345–349. Soper DE, Bump RC, Hurt WG: Wound infection after abdominal hysterectomy: Effect of the depth of subcutaneous tissue. 173(2):465–471. Moro ML, Carrieri MP, Tozzi AE, Lana S, Greco D: Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS Study Group. Annali Italiani Di Chirurgia 1996, 67(1):13–19. Derzie AJ, Silvestri F, Liriano E, Benotti P: Wound closure technique and acute wound complications in gastric surgery for morbid obesity: a prospective randomized trial. 2000, 191(3):238–243. Kim SI, Lim MC, Song YJ, Seo S-S, Kang S, Park S-Y: Application of a subcutaneous negative pressure drain without subcutaneous suture: impact on wound healing in gynecologic surgery. European Journal of Obstetrics Gynecology & Reproductive Biology, 173:94–100. Magann EF, Chauhan SP, Rodts-Palenik S, Bufkin L, Jr JNM, Morrison JC: Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: A randomized clinical trial. American Journal of Obstetrics & Gynecology, 186(6):1119–1123. Allaire AD, Fisch J, Mcmahon MJ: Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. 2000, 45(4):327. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3862909","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":271401340,"identity":"79b0faca-ec1b-4155-9b94-35880c32d403","order_by":0,"name":"Xie Yuan","email":"","orcid":"","institution":"Chengdu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xie","middleName":"","lastName":"Yuan","suffix":""},{"id":271401341,"identity":"76914036-9a57-4495-8433-3a74a5e2c88c","order_by":1,"name":"rui xu","email":"","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"rui","middleName":"","lastName":"xu","suffix":""},{"id":271401342,"identity":"53aaa92d-58da-4570-99ed-6d74c65eda2b","order_by":2,"name":"chao Yang","email":"","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"chao","middleName":"","lastName":"Yang","suffix":""},{"id":271401345,"identity":"d365b6e9-4f11-4dc5-9955-24cd622e4fe8","order_by":3,"name":"shuo-meng Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYDACZiBmbIByPhhI8PAzMx9+QLQWxhkVFnKS7WxpBgRtgmlh5jlTYWxwnkdBAp9qg+PMDx/+3HFYTre99/AL3jaJxM2HeRgMGGpsonFpkWxmMzbmPXPY2OzMuTQLSaCWbYd5DzxgOJaW24BDCz8zg5k0Y9vhxG03cswMDMFa+BIMGBsO49TCxsz+TfInSMv9N2YGiSCHNfMYSODTws/MYybBC7aFx/jBgTMSxgbMBLRINvMUG/O2pQP9kmPG2FAhISdxGBjICXj8YnD++MaHP9us5cyOnzH+/Megjoe///DhBx9qbHBqQfEXIjoSiFAOAswfiFQ4CkbBKBgFIwwAAIr4Wr98dnAtAAAAAElFTkSuQmCC","orcid":"","institution":"Sichuan Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"shuo-meng","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2024-01-14 09:59:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3862909/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3862909/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50820186,"identity":"3e37b49e-bfd2-41a7-bd5e-135c7d325d86","added_by":"auto","created_at":"2024-02-07 20:38:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":869617,"visible":true,"origin":"","legend":"\u003cp\u003eSilicone subcutaneous drainage tube with 14 F diameter was placed under the skin.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-3862909/v1/5af158251c3a9971ffa9b168.png"},{"id":50820189,"identity":"63e98a7e-c256-405f-a284-36781860ca27","added_by":"auto","created_at":"2024-02-07 20:38:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1298304,"visible":true,"origin":"","legend":"\u003cp\u003eThe skin was sutured by the skin stapler.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-3862909/v1/73e7b958b231537f3408d2af.png"},{"id":50820187,"identity":"00291195-c794-4e35-9999-3448b5d3b491","added_by":"auto","created_at":"2024-02-07 20:38:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1406577,"visible":true,"origin":"","legend":"\u003cp\u003eThe drainage tube was connected with a negative pressure ball.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-3862909/v1/b2a0a3fe752a996a8e6e32d2.png"},{"id":53132580,"identity":"f30e9178-1f5d-4aff-87d4-2bf7169b875f","added_by":"auto","created_at":"2024-03-21 03:14:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5928449,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3862909/v1/7296dc4e-f3e8-4334-af71-b986c72c75a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The safety and efficacy of subcutaneous negative pressure drainage to close midline epigastric incision: a retrospective case-control study","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgery was still the mainstay of treatment for gastric cancer. Although laparoscopy gastrectomy developed and used in early gastric cancer in recent years, open gastrectomy still was the classic procedure, especially for advanced gastric cancer[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The midline celiotomy was the most common procedure for open gastrectomy. The incidence of incision problem was 0.6 to 2.0%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These incision problems included surgical site infection (SSI), fat liquefaction, fluid accumulation and subcutaneous seroma formation[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These problems were easily treated, but prolonged hospital stay, increased the anxiety and reduced confidence, especially for cancer patients. Effective incision closure may enhance recovery and improve clinical outcomes.\u003c/p\u003e \u003cp\u003eWe learned at surgical school that in order to prevent dead space, the subcutaneous tissue must be closed precisely. The accumulation of serous fluid and necrotic tissue in the dead space would result in issues with the wound. A method named non-sutured subcutaneous fat tissue was mentioned in an abdominal surgery study[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. But this non-sutured method did not reduce the rate of complications. In this study, we replaced subcutaneous suture with a subcutaneous negative pressure drainage. The aim of this study was to compare the safety and efficacy of conventional subcutaneous suture and subcutaneous negative pressure drainage.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The study adhered to the Declaration of Helsinki. Individual informed consent was waived as this study was a retrospective analysis ,ethical approval was obtained from the ethics committee of Sichuan cancer hospital.(Approval No. SCCHEC-02-2018-048).All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003eAll patients enrolled in the study were diagnosed with gastric cancer and underwent open gastrectomy. Preoperative radiotherapy patients and those patients who had underwent middle laparotomy were excluded. Characteristics of patients and incision complications were collected. The Clavien-Dindo classification system was used to assess incision complications[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubcutaneous negative pressure drainage group\u003c/h2\u003e \u003cp\u003eAntibiotics was injected before skin incision half an hour and every 3 hours during surgery. After closure of linea alba had completed, saline solution was utilized to wash the subcutaneous tissue. Effective hemostasis was performed. Perforated silicone subcutaneous drainage tube with 14 F diameter was placed under the skin and the skin was sutured by the skin stapler (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After the skin was sutured, the drainage tube was connected to a negative pressure bulb (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When the daily drainage amount was less than 1 milliliter over a period of 24 hours, the subcutaneous drainage tube was removed. The skin stapler was typically extracted on the tenth day following surgery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSubcutaneous interrupted suture group\u003c/h2\u003e \u003cp\u003eAntibiotics was injected before skin incision half an hour and every 3 hours during surgery. The subcutaneous tissue was cleaned with a saline solution following the completion of the closure of the linea alba. The subcutaneous tissue was closed with an interrupted 3\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl suture to effectively establish hemostasis. In a similar manner, the skin stapler sutured the skin. Usually, the skin stapler was removed ten days after the procedure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis was conducted using SPSS Statistics 26. For numerical value, Student's t test and the mean difference (MD) with 95% confidence interval (CI) were used to assess the outcomes. For classified value, the x\u003csup\u003e2\u003c/sup\u003e test or Fisher\u0026rsquo;s exact test were used. A value of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom January 2015 to August 2016, four hundred and thirty patients undergoing gastrectomy with subcutaneous suture were included in our analysis. From September 2016 to July 2023, four hundred and fifty-six patients undergoing gastrectomy with subcutaneous negative pressure drainage were included. Characteristics of patients were detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. For all patients, nutrition screening was performed with Patient-Generated Subjective Global Assessment (PG-SGA) at the time of admission. In two groups, there were not significant differences in terms of PG-SGA, body mass index, hemoglobin, total protein and operation type.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcutaneous suture (n\u0026thinsp;=\u0026thinsp;430)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous drainage\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;456)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e429\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (m\u003csup\u003e2\u003c/sup\u003e/kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePG-SGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue:1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue:4\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue: \u0026ge;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121.01\u0026thinsp;\u0026plusmn;\u0026thinsp;23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120.3\u0026thinsp;\u0026plusmn;\u0026thinsp;26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal protein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eOperation type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal gastrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal gastrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal gastrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208.4\u0026thinsp;\u0026plusmn;\u0026thinsp;52.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204.8\u0026thinsp;\u0026plusmn;\u0026thinsp;55.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePG-SGA: Generated Subjective Global Assessment\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTotally, incision problem was found in nineteen patients in the subcutaneous suture group and in 2 patients in the subcutaneous negative pressure drainage group. All complication was classified as Clavien-Dindo grade\u0026thinsp;\u0026le;\u0026thinsp;II (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In subcutaneous suture group, the rate of infection was 1.86% (8/430). In the subcutaneous negative pressure drainage group, it was 0.22% (1/456). This rate was significantly lower in the subcutaneous negative pressure drainage group than that in the subcutaneous suture group(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015). No patient with fat liquefaction or fluid accumulation was found in the subcutaneous negative pressure drainage group. Fat liquefaction was found in six patients and fluid accumulation was found in five patients in the subcutaneous suture group. There were significantly differences between the two groups in terms of fat liquefaction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013) and fluid accumulation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027). In the subcutaneous group, bleeding was found in a patient after pulling out the drainage tube. Hemostasis by compression was performed and reoperation was avoided. In general, the rate of non-infection complications was also lower in the subcutaneous negative pressure drainage group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications of incision\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcutaneous suture (n\u0026thinsp;=\u0026thinsp;430)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcutaneous drainage (n\u0026thinsp;=\u0026thinsp;456)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eClavien-Dindo classification grade\u0026thinsp;\u0026le;\u0026thinsp;II\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon infection complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efat liquefaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efluid accumulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed two methods of subcutaneous tissue closure for gastric cancer patients undergoing open gastrectomy. These results showed that the rates of incision problems were lower in the subcutaneous drainage group than in the conventional subcutaneous suture group. These results would change clinical decision.\u003c/p\u003e \u003cp\u003eThe classical surgical procedure of midline incision closure is suturing of subcutaneous tissue. This type of procedure was considered as a method to close dead space and decrease incision complications[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Fragile tissue and fluid would deposit under the skin regardless of whether a continuous or interrupted suture technique was used. These additional materials could increase the risk of wound complications. Although most of incision problems were classified as Clavien-Dindo grade\u0026thinsp;\u0026le;\u0026thinsp;II, they would prolong hospital stay, increase the anxiety and reduce confidence. This technique involved the use of a drainage tube that was placed between the linea alba and the skin. The tube was connected to a negative pressure ball and maintained negative pressure. As a result, delicate tissue and fluid were successfully drained. This approach reduced liquid collection and seroma formation. In case of these conditions, caused SSI[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. All incisions were vertical in these patients enrolled in this study. The peritoneum and fascia layer were closed as a layer using an interrupted technique. This interrupted suture has the same incidence of incision problems compared to the continuous suture[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In conventional group, interrupted suture was used to close subcutaneous tissue. In trial group, no suture procedure was used.\u003c/p\u003e \u003cp\u003ePrevious studies showed that the depth of subcutaneous tissue, obesity, increased age, diabetes mellitus and immunosuppression were risk factors for incision complications[\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Soper showed that the depth of subcutaneous tissue was the only significant risk factor for incision infection[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. So, closure of subcutaneous tissue was an important procedure to prevent infection. Subcutaneous negative pressure drainage procedure had been used in gynecologic surgery[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These studies revealed this procedure was safe and effective for women patients. We firstly performed this procedure for elective epigastric surgery and got the same outcomes. This method could drain serous fluid and necrotic tissue out. Compared to the conventional interrupted suture, subcutaneous negative pressure drainage reduced the subcutaneous deposition and the rate of wound complications, and enhanced patient recovery. It would be a procedure of enhanced recovery after surgery.\u003c/p\u003e \u003cp\u003eThis study has some limits. Firstly, this was a retrospective study. To confirm these results, a prospective random study is needed in the future. Secondly, these enrolled patients only underwent open gastrectomy. For those patients who underwent the other epigastric surgery, it was unclear if this procedure was suitable.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSubcutaneous negative pressure drainage was safe and efficient. We suggested an application of a subcutaneous negative pressure drainage approach for open gastrectomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSSI: Surgical Site Infection\u003c/p\u003e\n\u003cp\u003ePG-SGA: Patient-Generated Subjective Global Assessment\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYuan Xie: write this manuscript, collect dataRui Xu:collect data and analysisChao Yang:collect data and analysisShuo-meng: Design, analysis and write\u003c/p\u003e\u003cp skip=\"true\"\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp skip=\"true\"\u003eConsent for the publication of images of participant.\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article .\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declared that they have no competing interests.\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding source for this study.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe give a thanks to all these patients enrolled in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJapanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 20(1):1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X: Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. \u003cem\u003eJournal of Clinical Oncology Official Journal of the American Society of Clinical Oncology\u003c/em\u003e:JCO.2015.2063.7215.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerashima M, Iwasaki Y, Mizusawa J, Katayama H, Nakamura K, Katai H, Yoshikawa T, Ito Y, Kaji M, Kimura Y: Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer, the short-term safety and surgical results: Japan Clinical Oncology Group Study (JCOG0501). \u003cem\u003eGastric Cancer\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuldamer L, Bonastre J, Brunet-Houdard S, Body G, Giraudeau B, Giraudeau B, Caille A, Caille A: Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. Bmj Open 2016, 6(4):-.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParal J, Ferko A, Varga J, Antos F, Plodr M, Lochman P, Subrt Z: Comparison of Sutured versus Non-Sutured Subcutaneous Fat Tissue in Abdominal Surgery. European Surgical Research, 39(6):350\u0026ndash;358.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDindo D: The Clavien\u0026ndash;Dindo Classification of Surgical Complications: Springer London; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKore S, Vyavaharkar M, Akolekar R, Toke A, Ambiye V: Comparison of Closure of Subcutaneous Tissue Versus Non-closure in Relation to Wound Disruption After Abdominal Hysterectomy in Obese Patients. 2000, 46(1):26\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcos S, Rodwan H, Katarina A, Cesar RFP, Renato Z, Milan J: Use of Quilting Sutures During Abdominoplasty to Prevent Seroma Formation: Are They Really Effective? Aesthetic Surgery Journal 2015(5):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards PC, BALCH CM, ALDRETE JS: A Randomized Prospective Study of 571 Patients Comparing Continuous vs. Interrupted Suture Techniques. Annals of Surgery, 197(2):238\u0026ndash;243.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTipton AM, Cohen SA, Chelmow D: Wound Infection in the Obese Pregnant Woman. 35(6):345\u0026ndash;349.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoper DE, Bump RC, Hurt WG: Wound infection after abdominal hysterectomy: Effect of the depth of subcutaneous tissue. 173(2):465\u0026ndash;471.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoro ML, Carrieri MP, Tozzi AE, Lana S, Greco D: Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS Study Group. Annali Italiani Di Chirurgia 1996, 67(1):13\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDerzie AJ, Silvestri F, Liriano E, Benotti P: Wound closure technique and acute wound complications in gastric surgery for morbid obesity: a prospective randomized trial. 2000, 191(3):238\u0026ndash;243.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SI, Lim MC, Song YJ, Seo S-S, Kang S, Park S-Y: Application of a subcutaneous negative pressure drain without subcutaneous suture: impact on wound healing in gynecologic surgery. European Journal of Obstetrics Gynecology \u0026amp; Reproductive Biology, 173:94\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagann EF, Chauhan SP, Rodts-Palenik S, Bufkin L, Jr JNM, Morrison JC: Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: A randomized clinical trial. American Journal of Obstetrics \u0026amp; Gynecology, 186(6):1119\u0026ndash;1123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllaire AD, Fisch J, Mcmahon MJ: Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. 2000, 45(4):327.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"subcutaneous drainage, incision closure, open gastrectomy","lastPublishedDoi":"10.21203/rs.3.rs-3862909/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3862909/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIncision complications were still a problem of open gastrectomy. Aim of this study was to assess the safety and efficacy of a method of closing incision, named subcutaneous negative pressure drainage.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective case-control study was designed to compare the safety and efficacy between subcutaneous suture and subcutaneous negative pressure drainage to close the midline epigastric incision. Clinical data of all the patients underwent open gastrectomy were collected. Characteristics of patients and incision complications were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom January 2015 to July 2023, 430 patients underwent subcutaneous suture and 456 patients underwent subcutaneous negative pressure drainage were included. There were not significantly differences between two groups in clinical characteristics. The rates of surgical site infection and non-infection complications were lower in the subcutaneous negative pressure drainage group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSubcutaneous negative pressure drainage was safe and efficient. This approach should be recommended for closure of midline incision.\u003c/p\u003e","manuscriptTitle":"The safety and efficacy of subcutaneous negative pressure drainage to close midline epigastric incision: a retrospective case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-07 20:38:49","doi":"10.21203/rs.3.rs-3862909/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75e6bd59-6edf-4e9a-9d40-a851f2317226","owner":[],"postedDate":"February 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28612444,"name":"Biological sciences/Cancer"},{"id":28612445,"name":"Health sciences/Diseases"}],"tags":[],"updatedAt":"2024-03-21T03:05:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-07 20:38:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3862909","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3862909","identity":"rs-3862909","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}