Abstract
Recent meta-analyses have shown that the application of a monofile, late-absorbable suture using a continuous suture technique with a suture-to-wound length ratio of at least 4:1 is the method of choice for the closure of midline laparotomies. Monomax, a new ultra-long term absorbable, high elastic monofilament suture, was approved in 2009 and its safety and efficacy were proven in a selected patient population under controlled conditions for elective midline abdominal wall closure (ISSAAC Study). The present multi-centric, international, prospective observational study is aimed at evaluating the performance of Monomax suture for transverse and midline abdominal wall closure in daily clinical practice even in high risk patients. A total of 200 patients undergoing a primary elective laparotomy using either a midline or transverse incision were examined regarding the frequency of short-term complications (e.g. reoperation due to burst abdomen, wound infection, wound healing disorders), until discharge and 1 month after surgery. Postoperative length of hospital stay was also reported. Frequency of reoperation due to burst abdomen was 2.5% and a wound infection rate of 3.5% was reported up to day of discharge. Seven patients developed a wound healing disorder (3.5%). Average length of postoperative hospital stay was 10.3 days. Our results indicate that the ultra-long term absorbable, elastic monofilament suture is safe and efficient for transverse and midline abdominal wall closure performed under daily clinical routine even in high risk patients.
Highlights
The abdomen is opened in the majority of cases by either a median or transverse laparotomy
The following additional risk factors were present in the study group: 25% current smoker, 16% diabetic patients (N = 32) of whom 28% were insulin-dependent; 12 patients were previously operated due to an abdominal aortic aneurysm
Based on the INLINE meta-analysis, the use of a monofilament, long-term absorbable suture is recommended for the continuous suture technique, with a suture-to-wound length ratio of at least 4: 1 for elective midline closures [8]
Summary
The abdomen is opened in the majority of cases by either a median or transverse laparotomy. The closure of both incisions did not show any significant differences with regard to short-term and long-term complications [1]. Numerous studies have addressed the question of the ideal suture material and the optimal suture technique for primary elective abdominal wall closure [2,3,4,5,6,7]. The following complication rates are reported for elective, primary abdominal wall surgery: burst abdomen 1-3%, wound infections 3-20% and incisional hernias 1 year postoperatively up to 20% respectively [2,3,4,5,6,7].
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