Prevention of incisional hernia

Abstract

Incisional hernia is the most frequent late complication of surgery; its incidence is constant and it has a high socio-economic impact. Possible preventive measures are analysed in this article on the basis of current clinical and experimental findings. An argument that is restricted strictly to the surgical and technical aspects does not do justice to the complexity of incisional hernia development. It has been proved that continuous mattress suturing after laparotomy is beneficial in terms of wound healing and also means significantly shorter operating times and smaller amounts of suture material are needed. Combined with a suture length-to-wound length ratio of at least 4:1, this technique is superior to single interrupted suturing as its bio-mechanical properties are better and it allows better collagen synthesis in the region of the incision. It is not possible to recommend any one particular suture material at present. The possibilities of influencing the endogenous risk factors connected with the patient and any co-morbidity is hampered by economic aspects and low efficiency, although precisely such endogenous factors have a high potential for influencing treatment in the future. Suture tension is a relevant parameter that has not yet been sufficiently fully evaluated. Better monitoring of suture tension might open up the possibility of devising new variants of laparotomy closure techniques that would reduce the incidence of incisional hernias. In view of the significance of impaired wound healing for the surgical specialties, suture tension and the search for possible ways of influencing and modulating collagen synthesis look like promising topics that would reward a more intense research effort in the future.