Abdominal Wall Closure Research Articles

Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries

Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.

Strategy of stage treatment for patients with perforated diverticulitis: first experience

BACKGROUND: The results of surgical treatment of patients with perforative diverticulitis of the colon are still unsatisfactory today. Since the majority of patients undergo Hartmann surgery, the main problem is a large number of stoma patients. Three quarters of them live with a stoma for a long time, which negatively affects their quality of life and increases the cost of treatment.
 AIM: The purpose of this research work is to improve the immediate results of treating patients with perforative diverticulitis and peritonitis by using staged surgical tactics.
 MATERIALS AND METHODS: The reaserach included 14 patients with perforative diverticulitis Hinchey grade II-III. The average value of the Mannheim peritoneal index is 18.9 ± 6.3 points. At the first stage of surgical treatment, all the patients underwent colon resection with a zone of perforation of the diverticulum and leaving its muffled ends in the abdominal cavity. After lavage and drainage, temporary closure of the anterior abdominal wall was performed. After 24–48 hours, all the patients underwent colon reconstraction.
 RESULTS: The average age of the patients was 52.3 ± 12.4 years with 4 women (28.6%) and 10 men (71.4%). The average duration of the first stage was 105.7 ± 27.2 minutes, the second one — 113.2 ± 40.5 minutes. The average hospital-stays were 16.4 ± 7.2 days. There were no anastomosis failures and no lethal outcomes. Complications were noted in 9 patients (64.3%), grade I according to Clavien – Dindo — 83.4%.
 CONCLUSIONS: The tactics of early surgical treatment is a promising concept for patients with perforative diverticulitis. It provides rapid elimination of the septic focus during the first surgical operation, assumes early reconstruction of the intestine without increasing the number of complications and mortality, and can be used in patients with peritonitis.

Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model.

Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting. Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered. The highest tensile force was measured when using barbed polydioxanone (334.8N ± 157.0), but differencesdid not reach statisticalsignificance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397N vs 271N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008). Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure.

Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.

A Cost-Effectiveness Analysis of Wittmann Patch-Assisted Abdominal Closure Compared to Planned Ventral Hernia in Management of the Open Abdomen.

Inability to achieve primary fascial closure after damage control laparotomy is a frequently encountered problem by acute care and trauma surgeons. This study aims to compare the cost-effectiveness of Wittmann patch-assisted closure to the planned ventral hernia closure. A literature review was performed to determine the probabilities and outcomes for Wittmann patch-assisted primary closure and planned ventral hernia closure techniques. Average utility scores were obtained by a patient-administered survey for the following: rate of successful surgeries (uncomplicated abdominal wall closure), surgical site infection, wound dehiscence, abdominal hernia and enterocutaneous fistula. A visual analogue scale (VAS) was utilized to assess the survey responses and then converted to quality-adjusted life years (QALYs). Total cost for each strategy was calculated using Medicare billing codes. A decision tree was generated with rollback and incremental cost-utility ratio (ICUR) analyses. Sensitivity analyses were performed to account for uncertainty. Wittmann patch-assisted closure was associated with higher clinical effectiveness of 19.43 QALYs compared to planned ventral hernia repair (19.38), with a relative cost reduction of US$7777. Rollback analysis supported Wittmann patch-assisted closure as the more cost-effective strategy. The resulting negative ICUR of -156,679.77 favored Wittmann patch-assisted closure. Monte Carlo analysis demonstrated a confidence of 96.8% that Wittmann patch-assisted closure was cost-effective. This study demonstrates using the Wittmann patch-assisted closure strategy as a more cost-efficient management of the open abdomen compared to the planned ventral hernia approach.

Incisional hernias: epidemiology, evidence and guidelines

From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in arange of up to 30% at 2‑year follow-up and even up to 60% at 5years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance. To present adescriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation. Aconcise summary was prepared incorporating the current literature and existing guidelines. According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be astandard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included. The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended.

Educating Residents in Abdominal Wall Closure: An Overview.

Background and Aims: Incisional hernia prevention has become an important concept for surgeons operating on the abdominal wall. Several techniques have been proposed to help decrease incisional hernia formation with suture closure of the abdominal wall being one of the cornerstones. Technical details that have been reported to decrease incisional hernia rates include achieving a 4:1 Suture to Wound length ratio and the use of a small bites technique. Despite evidence to support many of these techniques there appears to be a gap in practice patterns amongst practicing surgeons. Introducing and promoting these principles in surgical residency may help to close this gap. This paper reviews our experience with surgical training for abdominal wall closures at our institution. Materials and Methods: Programs and projects related to abdominal wall closure were reviewed from our institution from 2010-Present. Type of project, intervention, and impact on education was evaluated and summarized. Results: Seven projects were identified relating to surgical training and abdominal wall closure. Three projects dealt with skills training using an abdominal wall simulation model and related to suturing techniques. Two projects were clinical studies focused on suture to wound length ratios and improving outcomes with this variable in a residency training program. Two projects dealt with models relating to abdominal wall closure and education. Conclusion: Implementation of educational programs in surgical residency programs can lead to improvements in technique and knowledge around abdominal wall closure and help in research endeavors.

HPB P50 A comparison of layered vs mass closure in development of incisional hernia following Kocher’s incision for open cholecystectomy, a retrospective analysis

Abstract Background Incisional hernias are a common complication of abdominal surgery. Open cholecystectomy procedures predispose to development of incisional hernias. Studies have shown rates of incisional hernias in visceral abdominal surgery to be 12.6% at one year and 22.4% at 3 years [1]. Several techniques have been developed to reduce rates of incisional hernia, namely abdominal wall closure in layers rather than mass closure. The purpose of our study is to evaluate whether layered closure is superior in preventing incisional hernias compared to mass closure. Methods The study reviewed retrospective data on 694 cholecystectomies at Southport or Ormskirk NHS Trust between 2018-23. Of these cases, 104 underwent open procedures. Operation notes and follow up were accessed electronically and analysed. Patients were also contacted by telephone to further establish whether they have developed incisional hernias and discuss other complications following surgery. The primary objective was to compare hernia rates between mass and layered closure. Secondary objectives were to establish hernia incidence in relation to gender, age, BMI, and elective vs emergency surgery. Results Of the data analysed, there was an equal proportion of male and female patients. Median age of patients was 62. Median BMI of all patients was 29 and median BMI of those developing hernias was 37. 80.8% of open cholecystectomies were elective procedures and 19.2% were emergency procedures. Infection rate was found to be 3.8%, and 30-day mortality was 1.9%. The mean rate of incisional hernia was 7.7% with mean rates of mass and layered closure at 2.7% and 11.1%, respectively. Fisher’s exact test showed that there was no statistical significance in closure method on hernia development. Conclusions We found no statistical significance in incisional hernia development between mass and layered closure in open cholecystectomies. No statistical significance was seen in hernia development with relation to age, gender and elective vs emergency surgery, however greater BMI was found to be statistically significant in increasing risk of hernia development. Larger, prospective multi-centre data are needed to further evaluate these results and aid surgeons in choosing an optimal closure technique in the future.

Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study.

Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications fromGroups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.

Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: a randomized controlled trial [NCT00544583

BackgroundHigh-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy.Methods/designCONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up.ResultsFrom August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04–1.32).ConclusionThis RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.

Abdominal wall closure.

Abdominal wall closure.

Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Abstract Objective Surgical procedures manifest immense risks to patients. One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection (SSI). Although several efforts are being undertaken to determine the proper means to reduce such complications, there is still a high incidence of SSI worldwide. Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site. This study tested the effectiveness of an operating room (OR) bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery. Methods A quasi-experimental pretest and posttest design was utilized to determine its effectiveness. The study was composed of 60 participants divided into two groups: 30 subjects were selected to receive the OR bundle of care, while the other 30 subjects received the usual care. The groupings were determined through a systematic random sampling technique. The OR bundle of care had three interventions, namely: (1) maintaining perioperative normothermia, (2) no pre-operative surgical site hair removal, and (3) changing gloves before abdominal wall closure. These patients were evaluated using the standard instrument, Bates–Jensen Wound Assessment Tool (BWAT) in the post-intervention phases of the wound healing process, which are as follows: hemostasis, inflammatory, and proliferative phases. To describe the difference in the patients’ wound status after implementation of the OR bundle of care in each post-intervention phase, Friedman’s test was used. To describe the difference in the patients’ wound status in both groups after implementation of the OR bundle of care, the Mann–Whitney U test was used. Results The patient’s wound status was lower, indicating a more healing process. Differences between the wound status of the control and the experimental group were observed on the third postoperative day. This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring. A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed. Conclusions The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital, if there is uniform and consistent implementation of the said intervention.

SP9.14 “Happy to close?”: The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Abstract Introduction There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall closure (AWC) on IH rate. Our aim was to assess the rates of IH at 1 year following surgery between Registrar and Consultant surgeons in patients undergoing elective colorectal surgery. Methods Patients undergoing elective surgery for colorectal cancer between 2014-2018 were identified through the Hughes Abdominal Repair Trial (HART). Grade of surgeon performing AWC was categorised into “Trainee” and “Consultant” and compared with IH detected at clinical examination at 1 year following surgery. Results 663 patients were included. 44% were closed by registrars (n=289). Groups were comparable in BMI, previous surgery and pre-operative IH. The rate of IH in patients closed by registrars was significantly higher than those closed by consultants (20% vs 12%, p&amp;lt;0.01). Patients who underwent AWC by a registrar were 88% more likely to develop IH at 1 year (OR 1.88, 95%CI 1.23-2.86, p&amp;lt;0.01). When comparing AWC methods, IH rates were significantly higher in the Hughes closure arm (20% vs 12%, p=0.03), but not high enough in the mass closure arm to reach significance (21% vs 13%, p=0.05). Conclusion Patients who undergo AWC by a registrar have an increased risk of developing IH compared to those closed by a consultant. This work suggests the importance of training during AWC. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates, but AWC should be treated as training time rather than coffee time.

WTP5.7 The use of porcine dermal acellular matrix mesh for ventral and parastomal hernia: an evaluation of outcomes from a tertiary centre

Abstract Aims and Objectives Despite advancements in techniques for abdominal wall closure, 15-20% develop incisional hernia. Synthetic meshes are ill-advised for ventral-hernia repair at risk of wound-complications. Biologic grafts are an alternative given their biocompatible safety-profile. We evaluated the outcomes of fascial closure using a Porcine Dermal Acellular Matrix (PDAM) mesh (Cellis®). Methods A retrospective PDAM-mesh review was performed between 01/05/2016-30/09/2022, focusing on midline/parastomal hernias. Electronic charts were reviewed to obtain demographic and surgical data. Immediate/short-/long-term complications and radiological recurrence rates were collected. Results 71 cases (acute/elective 10/61, F:M 4:3) were included in the study, median age 62yrs (25-93yrs), follow-up 12-72mos. Majority (69%) of the elective group had ASA2 vs. 70% acutes had ASA3. Of the 61 elective repairs, midline hernias constituted 37 (60%) and parastomal hernias in 24 (40%). Of the 10 acute cases, there were 8 midline-hernias and 2 parastomal-hernias. Component separation (CS) were performed in 29 cases (16-bilateral anterior-CS, 11-unilateral anterior-CS and 2-bilateral posterior-CS). Median LOS was 11d (1-180d)/15d (1-159d) for elective/acute groups. Seromas and minor wound infections were the commonest short-term Cx in both groups. There were 5 deaths within 90-days. From the elective group 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias had CT recurrences. In the acute group, one recurrence each were noted from 8 midline repairs (12%) and 2 parastomal hernias. Conclusion Our PDAM-mesh cohort demonstrates acceptable results regarding managing midline-ventral and parastomal-hernias in the elective/acute setting. Further comparative studies with synthetic mesh are warranted to fully evaluate the effectiveness of PDAM meshes.

Damage control surgery in emergency general surgery: What you need to know.

Damage-control surgery (DCS) is a strategy adopted to limit initial operative interventions in the unstable surgical patient, delaying definitive repairs and abdominal wall closure until physiologic parameters have improved. Although this concept of "physiology over anatomy" was initially described in the management of severely injured trauma patients, the approaches of DCS have become common in the management of nontraumatic intra-abdominal emergencies.While the utilization of damage-control methods in emergency general surgery (EGS) is controversial, numerous studies have demonstrated improved outcomes, making DCS an essential technique for all acute care surgeons. Following a brief history of DCS and its indications in the EGS patient, the phases of DCS will be discussed including an in-depth review of preoperative resuscitation, techniques for intra-abdominal source control, temporary abdominal closure, intensive care unit (ICU) management of the open abdomen, and strategies to improve abdominal wall closure.

Developing a simulation training model for abdominal wall opening and closure

Developing a simulation training model for abdominal wall opening and closure

P-026 FASCIAL TRACTION WITH EPTFE MESH FOR DEFINITIVE CLOSURE OF CATASTROPHIC ADBOMEN

Abstract Aim Show the benefits of temporary closure with expanded polytetrafluoroethylene (ePTFE) mesh associated with negative pressure therapy (NPT) in the management of catastrophic abdomen. Material &amp; methods We present the case of a 74-year-old female who underwent emergency surgery for necrotising fasciitis of the abdominal wall and tertiary peritonitis after a vaginal hysterectomy and anterior colpoplasty, where the use of NPT combined with ePTFE mesh allowed gradual fascial traction until its complete closure (after ten days), restoring the functionality of the abdominal wall. Results Temporary abdominal wall closure using NPT with ePTFE mesh allows progressive fascial traction and early closure of the abdominal wall in cases of catastrophic abdomen with low complication rate. Conclusion Techniques for temporary abdominal wall closure have led to a significant mortality reduction in cases of complex abdomen. There are several techniques with unclear evidence as to which is optimal. The combined use of NPT with ePTFE mesh is a riveting alternative as it does not adhere to bowel serosa and the risk of eventrations and fistulas are less common.

P-041 3-YEAR RETROSPECTIVE ANALYSIS OF USE OF ONLAY PROPHYLACTIC MESH IN MIDLINE LAPAROTOMY FOR GASTRIC CANCER

Abstract Background Incisional hernias are a frequent complication of abdominal wall incisions, ranging from 12.8% to 69% in long-time series. Recent literature supports the use of prophylactic mesh placement to avoid long-term incisional hernias. Gastric surgery in our center is performed via midline laparotomy and prophylactic mesh placement is carried out as a usual practice. The objective of our study is to evaluate long-term results of prophylactic mesh in midline laparotomies for gastric cancer. Methods Observational retrospective analysis of all patients undergoing gastric cancer sugery via midline incision with use of a polypropliene autoadhesive prophylactic mesh, between the years 2019–2021. Outcome measures included demographics, comorbidities, wound complications, reinterventions, neoplastic recurrences and incisional hernias (diagnosed by CT scan). Results A cohort of 55 patients (80% male). Mean age 68.1 years old (41–86), BMI 25,75 kg/m2 (18.73–33). All patients operated for gastric cancer, abdominal wall closure with small bite technique (monofilament absorbable 2/0 suture) and autoadhesive onlay mesh. 72.7% distal subtotal gastrectomies. 89% elective surgery. Mean albumin in preoperative analytic 40.5 g/L. Postoperative complications: 72% Clavien-Dindo grade II, mean CCI 29 (including 4 reinterventions and 1 exitus). Mean follow-up 24.9 months: 8 (14.5%) neoplastic recurrences, 4 (7.3%) exitus for cancer progression and 3 (5.4%) incisional hernias diagnosed by CT Scan (none of them reoperated). No meshes have been removed. In a comparative study no risk factors for incisional hernia have been found. Conclusions In our setting, the use of polypropylene autoadhesive prophylactic meshes in midline incision for gastric cancer is safe and durable.

OC-044 MODIFIED CHEVREL TEHCNIQUE. A LIMITED OPTION FOR ABDOMINAL CLOSURE IN PATIENTS WITH ABDOMINAL HYPERTENSION

Abstract Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients. Several techniques have been described for abdominal wall closure after a damage control laparotomy to achieve static and dynamic support without leading to abdominal hypertension. Aim To describe short termn results after a modified Chevrel technique for midline incisional hernia repair in patients with abdominal hypertension. Materials and Methods We perfomed a modified Chevrel as an abdominal wall closure technique in 9 patients between January 2016 and January 2022. The inclusion criteria were patients surgical intervened from gastrointestinal diseases and postoperative complications who suffered from varying degrees of abdominal hypertension. We consider this surgical approach in symptomatic patients with intrabdominal pressures exceeding 20mmHg who were stable enough to undergo surgery. Results Nine patients were treated with this technique (6 male and 3 female). Their BMI ranged from morbidly obese to severe underweight. The main reasons why only one side of the fascia could be used were: The presence of a stoma, intrabdominal drains and inverted T-scars from previous surgeries. The use of mesh was dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed hernia recurrence, although we did have one case of bulging, one hematoma and one case of seroma. Our results are limited by a 33% mortality within the first two years. Conclusions The modified Chevrel technique can be used as an urgent surgical tool for closing midline defect in patients undergoing compartimental syndrome and abdominal hypertension.

V-013 NEW TECHNIQUE FOR ABDOMINAL WALL GRAFT RETRIEVAL

Abstract Aim show our technique for abdominal wall graft retrieval minimizing warm ischemia time. Material and methods a video report of an abdominal wall graft retrieval (full-thickness) from a female brain death donor. Results better graft perfusion with a lower picnosis in the studied cells. Lower tissue damage in both full-thickness and isolated fascia grafts. Surgical technique: An “house-flap” incision is done as opposed to a conventional cross-line laparotomy. The flap is extended until the inguinal ligament, divided afterwards to gain easier access to the femoral vessels. After abdominal organ dissection, the common iliac arteries are dissected from close to the aortic bifurcation up to the femoral vessels, beyond the origin of the inferior epigastric arteries. After cannulation of the aorta, cava vein and inferior mesenteric vein for the intraabdominal organs, both common iliac arteries are cannulated beyond the origin of external iliac artery. To achieve optimal perfusion of the rectus fascia we have to clamp the artery distal to the origin of the inferior epigastric artery (usually at the level of the femoral artery). The abdominal wall graft perfusion is done simultaneously with all the abdominal organs. Afterwards, we cover the graft with cold pads to avoid direct contact between the ice and the graft. A closure of the donor abdominal wall must be ensured after removing the wall graft. Conclusions our technique has showed better pathological outcomes than those previously published with a lower warm ischemia time of the abdominal wall graft.