Abstract
IntroductionThe risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent. The goal of this systematic review was to evaluate different closure techniques for midline laparotomies and the use of additional prophylactic mesh augmentation for midline closure in high risk patients. MethodA systematic literature search was performed until September 2017. The quality of the RCTs was evaluated and analysed. The data are reported in accordance with the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsIn the systematic review for closure techniques a total of 23 RCTs and 9 RCTs for the use of prophylactic mesh were included. In elective midline closure the use of a slowly absorbable suture material for continuous closure using the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). The use of prophylactic mesh versus the suture closure of the midline achieved a significant reduction of the incisional hernia rate [OR 0.14 (95% CI 0.07–0.27)]. ConclusionsBased on the currently evidence in midline closure after elective laparotomy in the small bites technique can be recommended to reduce significantly the rate of incisional hernia. The additional use of a prophylactic mesh in high risk patients can significantly reduce the occurrence of incisional hernia.
Highlights
The risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent
What about further risk factors associated with surgical performance like closure technique, suture material, surgical experience? In face of the paradigm shift in hernia surgery triggered by Usher [3] with the first use of prosthetic meshes at the beginning of the 1980s the problem of Midline Closure appropriate and safe closure after midline laparotomy is still an issue
Six studies described the suture to wound length ratio of 4:1 but only the study of Millbourn et al [11] and the STITCH –trial [12] analysed the ratio. These two studies are the only available RCT’s concerning the defined type of closure with slowly absorbable monofilament suture material in continuous technique comparing small versus large bite technique which is supposed to be the recommended closure technique after elective midline laparotomy regarding
Summary
The risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent. Over several generations of surgeons, the mass-layer single stitch suture has been the most commonly used technique for closure of the midline incision. This technique has had varying degrees of success in its application, especially in difficult secondary closures, e.g., burst abdomen complications. Parallel to the developments in meshes, there are different suture materials applicable for the closure of the abdominal wall in incisional hernia surgery as well as for primary midline closure
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
