A Randomized Controlled Trial on Effectiveness of Quilting Method in Ventral Hernia and Its Outcome in a Tertiary Care Hospital

Background: Ventral hernia repair often involves onlay mesh placement, which can create a dead space leading to seroma formation. Seroma – an accumulation of serous fluid in the surgical wound – is a common postoperative complication. Quilting sutures, which tack the subcutaneous flap to the underlying fascia, are proposed to obliterate dead space and reduce seroma. We conducted a randomized controlled trial (RCT) to evaluate whether quilting sutures reduce postoperative complications in ventral hernia repair. Material and Methods: In this prospective RCT, 73 patients undergoing elective onlay mesh repair for ventral/incisional hernia were randomized to either standard closure (No Quilting, n=38) or closure with additional quilting sutures (Quilting, n=35) of the subcutaneous flap to the rectus sheath. Key outcomes were postoperative seroma volume (day 1 and total), time to drain removal, length of hospital stay, surgical site infection (SSI), and wound dehiscence. Wound condition was graded using a standardized score on days 1, 3, 7, and 14. Results: Baseline demographics (age, gender) were similar between groups (Table 1). On postoperative day 1, mean seroma volume was significantly lower in the Quilting group (37.4 ± 10.7 mL) than in controls (44.7 ± 8.9 mL; p = 0.002). Cumulative seroma output was also markedly reduced with quilting (311.1 ± 99.3 mL vs 432.1 ± 113.1 mL; p<0.001). Patients who had quilting required drains for fewer days (7.4 ± 1.6 vs 10.5 ± 2.2 days; p<0.001) and had shorter hospital stays (8.8 ± 1.9 vs 14.6 ± 6.0 days; p<0.001). Quilting patients had better wound healing scores by day 7. Notably, surgical site infections were significantly lower in the Quilting group (21 of 35, 60.0%) than in controls (33 of 38, 86.8%; p = 0.009). Wound dehiscence rates were low and not significantly different. Conclusion: Quilting sutures significantly reduced postoperative seroma volumes, shortened drainage time, and lowered infection rates in open ventral hernia repair. These findings support routine use of quilting to eliminate dead space in hernia surgeries. Further studies should confirm the long-term impact on hernia recurrence.

Keywords: Ventral hernia, seroma, quilting sutures, randomized controlled trial, wound infection.