***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: This study describes a prospect i ve r and omized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds . Consecutive patients undergoing abdominal operation — elective and emergency surgery — through a midline abdominal wound were r and omized to have the peritoneal layer closed with continuous catgut , or to have this step omitted . The linea alba was closed with interrupted stainless steel sutures , and the skin approximated with staples . Patients were evaluated for wound sepsis , wound dehiscence , and subsequent incisional hernia development . Postoperative pain was assessed by a self-administered visual analogue score , and by measuring narcotic requirements . There was no significant difference in narcotic requirements , pain scores , or wound complications between the 2 groups . Single-layer closure of the abdominal wall is quicker , less costly , and theoretically safer than layered closure , and it is recommended that separate suture of the peritoneum be ab and oned . ResuméDans cette étude prospect i ve , r and omisée , et contrôlée , nous avons cherché à savoir si la fermeture individualisée du péritoine était nécessaire dans la fermeture d'une laparotomie médiane . Deux cents patients consécutifs — opérés à froid ou en urgence — par laparotomie médiane  , ont été r and omisés : dans un groupe , le péritoine a été fermé en un plan individualisé par un surjet au catgut , dans l'autre , le péritoine n'a pas été suturé . La ligne blanche a été fermée en un plan par des points séparés de fils d'acier ; la peau a été fermée par des agrafes . On a étudié le nombre des abcès de paroi , des éviscérations , et , à distance , des éventrations . La douleur postopératoire a été évaluée par un score analogue visuel , établi par le patient lui-même , ainsi que par la nécessité d'utiliser des antalgiques . Il n'y avait pas de différence significative entre les 2 groupes en ce qui concerne le taux de complications pariétales ou l'existence de douleur . Comme la fermeture pariétale en un seul plan est plus rapide , coûte moins cher , et , est théoriquement plus sûre ( on peut surveiller le contenu intrapéritonéal pendant la fermeture ) que la fermeture plan par plan , nous recomm and ons d'ab and oner la fermeture individualisée du péritoine . ResumenEl presente articulo describe un ensayo clínico prospect ivo destinado a investigar si es necesaria la sutura de la capa peritoneal como un paso independiente en el cierre de incisiones abdominales de línea media . Una serie de pacientes consecutivos sometidos a operaciones abdominales fueron r and omizados a cierre peritoneal con sutura continua de catgut  o a omisión de este paso . La línea alba fue cerrada con suturas interrumpidas de acero inoxidable y la piel con agrafes . Se estudió la incidencia de infección de herida , de dehiscencia , y de desarrollo de hernia incisional subsiguientes . La valoración del dolor postoperatorio fue realizada mediante autoevaluación con una escala linear análoga y la determinación de los requerimientos de narcóticos . No se encontraron diferencias significativas en el requerimiento de narcóticos para analgesia , en el nivel de la escala de dolor , o en la tasa de complicaciones entre los 2 grupos . El cierre de la pared abdominal en una capa única es más rápido , menos costoso , y teóricamente más seguro ; por lo tanto , se recomienda ab and onar la sutura del peritoneo Purpose Different suture techniques and various suture material s are in use to close midline incisions after primary laparotomy . The ISSAAC study aim ed to assess the safety and efficacy of the new ultra-long-term absorbable , elastic monofilament suture material MonoMax ® for abdominal wall closure . Methods This is a single-arm , multicentre prospect i ve study that included 150 patients undergoing a primary elective midline incision . The control group consists of 141 patients from the INSECT study who received MonoPlus ® or PDS ® for abdominal wall closure . The incidences of burst abdomen and wound infection until the day of discharge were defined as the primary composite endpoints . The rate of incisional hernias 1 year after surgery , the length of postoperative hospital stay and safety parameters served as secondary endpoints . The study has been registered under www . clinical trials.gov [ NCT005725079 ] . Results Eleven patients in the ISSAAC study [ 7.3 % ; 95 % CI = ( 3.9 ; 13.1 % ) ] experienced wound infection or burst abdomen until the day of discharge as compared to 16 [ 11.3 % ; 95 % CI = ( 6.6 ; 17.8 % ) ] patients in the INSECT control group ( p = 0.31 ) . The length of postoperative hospital stay was comparable in both study groups . One year after surgery , incisional hernias were observed in 21 ISSAAC patients ( 14.0 % ) in contrast to 30 hernias ( 21.3 % ) in the INSECT control group . Conclusions The ultra-long-term absorbable , elastic monofilament suture material MonoMax ® is safe and efficient for abdominal wall closure The lateral paramedian incision has been advocated as the strongest incision for abdominal surgery . We have evaluated this incision and tested the necessity for closing the deep peritoneal layer by a prospect i ve r and omized trial . All 206 patients undergoing laparotomy in the Surgical Unit in 1984 , both elective and emergency cases , were included . In patients undergoing laparotomy through unscarred tissue , a lateral paramedian incision was performed and they were r and omized to have either the peritoneum closed ( n = 77 ) or left open ( n = 75 ) . Patients in whom the laparotomy was performed through a previous incision ( n = 51 ) and those in whom the abdomen had to be opened urgently ( n =3 ) were excluded from the trial but studied separately ( n = 54 ) . The rectus sheath was closed with monofilament nylon in all cases . Patients were assessed for wound integrity during the immediate postoperative period and at 1 , 3 , 6 and 12 months after operation . So far the patients have been followed up for between 1 and 2 years and follow‐up is continuing as in some cases incisional hernia may not be detected until several years after operation . There have been no cases of burst abdomen . No incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed , and one incisional hernia has occurred in the patients in whom the peritoneum was left open . Seven incisional hernias have occurred in patients excluded from the trial of the lateral paramedian incision ( 13 per cent ) . We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare . It is not necessary to close the peritoneum with this incision Objective : To determine the volume of pelvic fluid and febrile morbidity after hysterectomy in which the peritoneum was or was not closed . Design : Prospect i ve single-center study . Participants : Fifty-four women undergoing abdominal hysterectomy were enrolled in the study . Patients were r and omized into two groups according to peritoneal closure : group I ( n = 28 ) in which the peritoneum was closed , and group II ( n = 26 ) in which the peritoneum was left open . All participants had early postoperative transvaginal ultrasound . Outcome Measures : Volume of pelvic fluid accumulated after hysterectomy , total leukocytic count before and after hysterectomy , body temperature over the first 24 h , and wound healing . Results : There was a statistically significant difference between both groups regarding the volume of pelvic fluid collection , the duration of the operation and number of ampoules needed ( p < 0.05 ) . There was no statistically significant difference regarding body temperature , TLC , and wound complications . Conclusion : Peritoneal non-closure does not increase short-term morbidity , however it does cause an increase in peritoneal pelvic fluid . The impact of this on long-term sequelae as adhesions should be investigated Abstract . Background : A transverse skin crease incision for right hemicolectomy may result in more rapid recovery than traditional vertical midline incision . This hypothesis was tested with a prospect i ve r and omised trial . Methods : Patients from 2 centres undergoing right hemicolectomy were r and omised to received a  midline or transverse incision . Incision lengths were sufficient to enable unrestricted resection of the right colon . Patients and carers were blinded to the incisions using strategically placed dressings . Analgesia and oral intake were controlled by the patient . Operative details and recovery parameters were compared . Results : A total of 28 patients were r and omised . Demographic data and tumour characteristics of the two treatment groups were similar . The transverse incision group had a slightly shorter median wound ( 10 cm vs. 11 cm , p<0.05 ) . Operative time , analgesia requirements , recovery parameters ( time to discharge , 6.5 vs. 6.5 days ) and frequency of complications were otherwise comparable . Conclusions : A transverse skin crease incision for right hemicolectomy results in a slightly smaller wound but no other advantages were demonstrated compared with a traditional vertical midline incision The effects of pelvic and periaortic peritoneal closure or ( non-closure ) on morbidity and adhesion formation were prospect ively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy .  Hysterectomy with bilateral salpingoophorectomy , bilateral pelvic and periaortic lymphadenectomy , omentectomy , appendectomy and lysis of pelvic adhesions for the st and ardization of initial adhesion scores was performed on all patients . The pelvic and periaortic peritoneum were re-approximated in group I ( n = 50 ) patients , and left open in group II ( n = 52 ) patients . The groups were similar for mean age , previous surgery , tumour histology and disease stage . Morbidity characteristics such as blood loss , transfusion rate , post-operative infectious and non-infectious complications , and total hospital stay were also similar . After six courses of PAC ( cisplatin 50 mg/m(2 ) , Adriamycin 50 mg/m(2 ) , cyclophosphamide 500 Mg/M(2 ) ) chemotherapy , all patients underwent a second-look laparotomy . Persistent cancer was detected in 49 of 102 ( 48.03 % ) patients . Adhesion scores were detected at the time of second-look laparotomy . Adhesion scores for group I ( 8.9 + /- 2.9 ) were significantly higher than the group II ( peritoneum non-closure ) ( 5.8 + /- 2.3 ) ( P<0.01 ) . Closing the pelvic and periaortic peritoneum did not effect morbidity , but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . Objective To compare closure and nonclosure of the peritoneum at radical abdominal hysterectonmy and pelvic node dissection with respect to postoperative morbidity . Methods Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned r and omly to have a st and ard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed . Adjuvant radiotherapy was given to patients with risk factors . The postoperative incidence of lymphocysts ( within 8 weeks from the operation and after 1 year ) and infection-related and non-infection-related complications were analyzed . Results One hundred twenty subjects were enrolled , of whom 59 had peritoneal closure and 61 did not . Both groups were similar with regard to age , weight , nodes removed , nodal metastases , operative time , type of surgery , need for transfusion , and incidence of postoperative radiotherapy . The median follow-up was 36 months ( range 11–72 ) . Eleven patients died , four because of treatment-related complication . The amount of drainage was significantly higher in the closed group than in the unclosed group ( median 740 mL , range 50–5980 versus median 340 mL , range 40–4000 ; P < .005 ) . The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks ( 17 of 59 versus 15 of 6 , respectively ) , at 8 weeks ( eight of  
    Output:
    
There is no evidence for any short-term or long-term advantage in peritoneal closure for non-obstetric operations .