Abstract
PurposeAn incisional hernia occurs frequently after a midline incision with an incidence of 12.8%. The choice in suture material used for abdominal wall closure is not straightforward and the conflicting literature focuses on clinical outcomes. This study compares a non-absorbable, slow-absorbable and fast-absorbable suture in a rat model, focusing on histological outcomes predicting better fascia healing.Methods33 male Wistar rats, divided over three groups, each received two separate 1 cm incisions closed with either Prolene 4/0, PDS 4/0 or Vicryl 4/0. At 7 days and 21 days, one of the incisions was explanted. Tissue was semi-quantitatively scored regarding inflammatory cells and collagen fibres present. Using qPCR macrophage polarisation, fibroblast activity and vascularisation were evaluated. Data were analysed by Kruskal–Wallis test with Mann–Whitney U post hoc test. A p value of 0.017 was considered significant after Bonferroni correction.ResultsAll animals recovered without complications and completed the 21 days of follow-up. The Vicryl group showed a higher presence of macrophages after 21 days in comparison with Prolene (p = 0.003) and PDS (p = 0.006) and more foreign body giant cells compared to Prolene at 7 days (p = 0.010) and PDS at 21 days (p < 0.001). qPCR showed 2.5-fold higher expression of clec10A in PDS compared to Prolene after 7 days (p = 0.007).ConclusionsThe results of this study carefully support the use of PDS suture, compared to Prolene and Vicryl, in abdominal wall closure based on a favourable macrophage response. The heterogeneity and variability in the data might be explained by the spectrum of the macrophage subtype paradigm.
Highlights
An incisional hernia is a frequent complication following abdominal surgery and is defined as any abdominal wall gap with or without a bulge in the area of a postoperative scar perceptible or palpable by clinical examination or imaging [1, 2]
The aim of this study is to investigate the effect of different types of suture materials on the healing of the abdominal wall in a rat model
The overall presence of macrophages decreased but remained significantly higher in the Vicryl group compared to both Prolene (p = 0.003) and PDS (p = 0.006) at 21 days of follow-up
Summary
An incisional hernia is a frequent complication following abdominal surgery and is defined as any abdominal wall gap with or without a bulge in the area of a postoperative scar perceptible or palpable by clinical examination or imaging [1, 2]. Discomfort or pain and cosmetic issues have a significant impact on the quality of life of patients [3]. At a weighted mean follow-up of 23.7 months, 12.8% of the patients have developed an incisional hernia and the estimated risk to undergo an incisional hernia repair after a midline incision is 5.2% [4]. In high-risk patients, the incidence increases to up to 30% [5, 6]. The identified patient-related risk factors are obesity (BMI > 25 kg/m2), the presence of an abdominal aortic aneurysm and congenital connective tissue disorders [7,8,9,10,11,12].
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