Abstract
BackgroundDevelopment of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery.MethodsTwelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75–95%, overall agreement 50–75%, no consensus <50%.Results157 out of 599 patients were eligible for analysis (85 (54%) midline, 54 (35%) transverse incisions). After midline incisions the fascia was closed continuously in 55 patients (65%), using slowly absorbable (n = 47, 55%), braided (n = 32, 38%) sutures with a strength of 1 (n = 48, 57%). In the transverse setting the fascia was closed continuously in 39 patients (72%) with slowly absorbable (n = 22, 41%) braided sutures (n = 27, 50%) with a strength of 1 (n = 30, 56%).ConclusionIn the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group) is performed on a consensus level.
Highlights
Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity
Sion, suture material used for fascia closure, the technique used for fascia closure, the use of subcutaneous suture and subcutaneous drainage, and the method of skin closure
After exclusion of patients with previous open abdominal surgery, an emergency procedure, and laparoscopic procedures, a total of 157 patients with primary elective laparotomy were available for further analysis (Figure 1)
Summary
Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. Regarding pathogenesis of incisional hernias, the incision type (midline vs transverse vs oblique) and the strategy of fascia closure, i.e. the combination of applied suture technique (interrupted vs continuous) and suture material (monofilament vs braided; absorbable (rapidly, intermediately, slowly) vs non-absorbable) are the main factors amenable to the surgeon. Based on the lack of data from well-designed long-term surgical trials, a large multi-centre randomized controlled trial (interrupted or continuous slowly absorbable sutures – evaluation of abdominal closure techniques, INSECTTrial) recruited 624 patients between 2004 and 2006 with the rationale to compare the most relevant surgical practices for abdominal fascia closure after primary midline laparotomy [13].
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