Development Of Incisional Hernia Research Articles

Abdominal Closure and the Risk of Incisional Hernia in Aneurysm Surgery – A Systematic Review and Meta-analysis

Patients with abdominal aortic aneurysms (AAAs) have a high prevalence of incisional hernia following open repair. The choice of incision and closure technique has a significant impact on this post-operative complication. Multiple techniques exist, as well as various comparative analyses, but clinical consensus is lacking. The objective was to perform a systematic review and meta-analysis of AAA laparotomy and closure technique and the risk of incisional hernia development. The systematic review was performed according to the PRISMA guidelines. A literature search of all original research published until January 2019 was made. Outcome measures were surgical approach, closure technique, hernia rates, length of follow up, and method of hernia recognition. Groups were divided according to method of abdominal incision and closure technique. Differences in outcome between closure techniques were expressed as risk ratios with 95% confidence interval (CI) using a random effects model. Fifteen studies were included with a cumulative cohort of between 388 and 3 399 patients compared in each group. Abdominal closure with a suture to wound length ratio of more than 4:1 compared with less than 4:1, RR 0.42 (95% CI 0.27–0.65), and abdominal closure with mesh compared with without mesh augmentation, RR 0.24 (95% CI 0.10–0.60) reduced the risk of incisional hernia. There were no significant differences in incisional hernia rate between transverse abdominal incision vs. vertical midline incision, RR 0.57 (95% CI 0.31–1.06) and between midline transperitoneal vs. all retroperitoneal incisions, RR 1.19 (95% CI 0.54–2.61). Choice of abdominal closure technique after aneurysm surgery impacts the risk of developing incisional hernia. The use of a supportive mesh significantly reduces the risk of incisional hernia in vertical midline incisions. The same is true if a suture to wound ratio of more than 4:1 is used.

Idiopathic urinary bladder rupture in two mares

Urinary bladder rupture is rarely reported in adult horses and is usually associated with parturition, history of traumaor urethral obstruction. This paper reports two cases in mares free of these predisposing factors, diagnosed throughclinical manifestations, abdominal ultrasound and abdominocentesis, corrected by cystorrhaphy through laparotomy.While recovery was satisfactory in one case, the other case had complications in celiorraphy such as development ofincisional hernia, small colon eventration and intestinal adherences, opting by the euthanasia of the animal. These reportsare important because of the rarity with which they occur in adult mares. The different prognoses may be related to theseverity of each case, according to the location and extension of the wound, which directly or indirectly influence thetechnique and recovery of the animals.

Predictors and Outcomes of Paramedian Incisional Hernia After Anterior Spine Exposure

BackgroundAnterior exposures for lumbar spine surgery are increasingly common for treating various spinal pathologies. A retroperitoneal approach via a paramedian incision has grown rapidly in popularity, but little is known about the risk of incisional hernia development with this technique. We sought to assess the incidence of paramedian incisional hernia development and identify risk factors that are associated with occurrence. Materials and methodsWe conducted a retrospective review of all patients who underwent anterior lumbar spine exposure by a paramedian approach between 2012 and 2017 at a single, tertiary medical center. The primary outcome was the development of postoperative paramedian incisional hernia. ResultsOf the 735 patients included in the study, 445 (60.5%) were women, and the mean (standard deviation) age of all patients was 60 y (12.4). Nearly all (97.4%) paramedian approaches were performed with a vascular surgeon present. Median follow-up time was 10 mo (interquartile range 3.5-19.9). Postoperative paramedian hernia developed in 20 patients (2.7%), of which 14 underwent repair. The mean (standard deviation) size of the hernia was 13.5 cm (5.5); 9 of 14 (64%) were repaired with synthetic mesh, whereas 3 of 14 (21%) required bowel resection. On multivariate analysis, risk factors associated with hernia development were male gender (0.045), higher American Society of Anesthesiologists class (0.039), history of abdominal surgery (P = 0.013), and postoperative intensive care unit admission (P = 0.02). ConclusionsA paramedian approach for anterior lumbar spine exposure resulted in a low rate of incisional hernia with minimal morbidity. Surgeons involved in these collaborative procedures should consider the risk factors that predispose patients to develop these hernias.

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow-up of the randomized PATRASTOM trial.

Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma-site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow-up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow-up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow-up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. Follow-up - either clinical or radiological - was available for 47 of the 60 PATRASTOM participants. The median duration of follow-up was 3.4years (interquartile range 3.0-4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P=0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. In the present follow-up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.

Association of Genetic Risk of Obesity with Postoperative Complications Using Mendelian Randomization.

The extent to which obesity and genetics determine postoperative complications is incompletely understood. We performed a retrospective study using two population cohorts with electronic health record (EHR) data. The first included 736,726 adults with body mass index (BMI) recorded between 1990 and 2017 at Vanderbilt University Medical Center. The second cohort consisted of 65,174 individuals from 12 institutions contributing EHR and genome-wide genotyping data to the Electronic Medical Records and Genomics (eMERGE) Network. Pairwise logistic regression analyses were used to measure the association of BMI categories with postoperative complications derived from International Classification of Disease-9 codes, including postoperative infection, incisional hernia, and intestinal obstruction. A genetic risk score was constructed from 97 obesity-risk single-nucleotide polymorphisms for a Mendelian randomization study to determine the association of genetic risk of obesity on postoperative complications. Logistic regression analyses were adjusted for sex, age, site, and race/principal components. Individuals with overweight or obese BMI (≥25kg/m2) had increased risk of incisional hernia (odds ratio [OR] 1.7-5.5, p < 3.1 × 10-20), and people with obesity (BMI ≥ 30kg/m2) had increased risk of postoperative infection (OR 1.2-2.3, p < 2.5 × 10-5). In the eMERGE cohort, genetically predicted BMI was associated with incisional hernia (OR 2.1 [95% CI 1.8-2.5], p = 1.4 × 10-6) and postoperative infection (OR 1.6 [95% CI 1.4-1.9], p = 3.1 × 10-6). Association findings were similar after limitation of the cohorts to those who underwent abdominal procedures. Clinical and Mendelian randomization studies suggest that obesity, as measured by BMI, is associated with the development of postoperative incisional hernia and infection.

Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement.

The primary aim of this study was to identify the incisional hernia rate after temporary loop ileostomy closure. Secondary outcomes were determining the risk factors linked to this incisional hernia, which could improve the patient selection for mesh prophylaxis. Retrospective cohort study of all consecutive patients with temporary loopileostomy reversal through a peristomal incision from 1st January 2011 to 1st January 2017 at our centre. Data were extracted from electronic clinical records: baseline patient characteristics, surgical factors and postoperative events. CT scans performed during follow-up were precisely analysed. Survival analysis was applied to identify risk factors for hernia development. 129 patients were analysed of whom 15 (11.6%) developed an incisional hernia at previous ileostomy site. The median time for incisional hernia development was 11months (IQR = 7-21) and the median follow-up time was 37months (IQR = 22-57). The identified patient risk factors for hernia development in survival analysis were female sex, older age, higher Body Mass Index, clinically significant parastomal hernia, clinically detectable midline incisional hernia and major postoperative complications ranked as Clavien-Dindo gradeIIIandIV. Incisional hernia after temporary loop ileostomy is a relevant problem that affects at least one in every ten patients. The previously cited risk factors might favour its development, therefore the use of a prophylactic mesh should be considered in those high-risk patients.

Does perfusion matter? Preoperative prediction of incisional hernia development.

Incisional hernias complicate 12-15% of general surgery cases with higher rates reported after laparotomy for aortoiliac occlusive disease (10-17%) and aneurysmal disease (17-38%). We hypothesize that inadequate perfusion of the abdominal wall promotes future hernia development. Thirty-eight patients undergoing midline laparotomy or thoracoabdominal approach for aortic disease with at least 2years of follow-up were included in the study. Preoperative imaging was reviewed to assess vessel patency, contributing to the abdominal wall perfusion. Patency of the superior epigastric artery was determined at the T10 level, the inferior epigastric artery at the L4 level, and the deep circumflex iliac artery at the anterior superior iliac spine. Lumbar arteries were considered patent if they were seen branching from the aorta. Clinic notes and hospital medical records were reviewed to evaluate the hernia development post-procedure. Thirteen patients (34%) developed an incisional hernia. Absent flow from bilateral superior epigastric arteries or absent flow from ipsilateral superior and inferior epigastric arteries was found to be predictive of hernia development (P = 0.013, 0.011, respectively). There was no association identified with perfusion from the lumbar or deep circumflex iliac arteries. Absent patency of the abdominal wall vasculature is a novel risk factor for incisional hernia development in the setting of aortic disease. Preoperative assessment of perfusion may convey the risk of hernia development and may be a tool to guide measures such as prophylactic mesh placement to reduce the future risk of incisional hernia.

Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections.

Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.

Incisional hernia at the site of stoma reversal\u2014incidence and risk factors in a retrospective observational analysis

BackgroundThe closure of a stoma site has a high incidence of incisional hernia (IH) development, reaching 30% in some studies. Location and defect size in the abdominal wall depend on the type of stoma formed, most commonly a loop ileostomy or terminal sigmoid colostomy.MethodsThe retrospective single-centre study includes all consecutive patients who underwent stoma reversal between 2010 and 2016 at the Department of Visceral, Transplant and Thoracic Surgery in Innsbruck. Patient characteristics and follow-up examinations were evaluated for IH at both the stoma reversal site and at any other surgical access sites.ResultsA total of 181 patients (49% female, 51% male) had a stoma reversal operation. A parastomal hernia was present in 5% (n = 9). Follow-up data was available for 140 patients (77%). A postoperative IH at the stoma reversal site developed in 15.7% (n = 22) and in 18.6% (n = 26) at other surgical wounds to the abdominal wall during a median follow-up of 136 weeks. The combination of a preoperative parastomal hernia and a postoperative IH was observed in 2.8% (n = 5). Parastomal herniation, male sex, body mass index over 25, arterial hypertension and concomitant ventral hernia were associated with IH formation at the stoma reversal.ConclusionThe rate of IH at the stoma reversal site was lower than expected from the literature, whereas the rate of IH at other surgical wounds to the abdominal wall was within the expected range.

Reduced rate of incisional hernia after standardized fascial closure in emergency laparotomy

Emergency laparotomy is a high-risk procedure, and incisional hernia is a common complication. This study aimed to investigate whether a standardized fascial closure technique, using slowly absorbable monofilament suture in a ratio of at least 1:4, could reduce the long-term occurrence of incisional hernia after emergency laparotomy. The single-center study was conducted as a questionnaire study including all patients who had an emergency laparotomy at Copenhagen University Hospital Herlev from May 2009 to May 2013 and June 2014 to November 2015. The historic cohort was used as a control. In the historic cohort of 2009-2013, different fascial closing techniques were used according to the preference of the individual surgeon. On June 1, 2014, we introduced a standardized method of fascial closure. A total of 465 patients met our inclusion criteria. The response rate was 77%. In all, 104 patients developed an incisional hernia: 77(27.0%) in the historic group and 27(15.0%) in the 2014-2015 group (p = 0.02). At long-term follow-up, 104 patients had undergone elective incisional herniotomy or had an incisional hernia confirmed by a medical doctor. The rate of incisional hernia was reduced from 27.0 to 15.0% (p = 0.02) comparing years 2009-2013 with 2014-2015. This study suggests that development of incisional hernia may be reduced significantly if a standardized technique is applied using slowly absorbable monofilament suture in a ratio of at least 1:4 in emergency laparotomies.

Is there any superiority of the different abdominal closure techniques for primary closure in high-risk patients?

IntroductionIncisional hernia continues to be one of the major problems of surgery due to its high incidence rate and high morbidity. The aims of this study are to compare different repair techniques with primary repair techniques for the risk of incisional hernia.Material and methodsHigh-risk patients who had a midline incision of the abdomen were included in this study. Patients were divided into four groups. Each group contained 20 patients. Patients of group 1 were operated on using primary repair. In group 2 Cardiff repair technique was used. The patients in group 3 were repaired with Keel technique. The patients of group 4 were repaired with onlay technique. Patients were followed up with physical examination at 3-month periods in the first year after surgery and 6-month periods in the following two years. Incisional hernia, occurrence time and other complications were noted.ResultsEighty patients who had high risk of incisional hernia were included in this study. 47.5% of them were female and 52.5% of them were male. The average age of patients was 59.2 ±12.95. Average hospitalization time was 8.5 days (4–28 days). Average follow-up was 18 months (6–34 months). In total 4 (5%) patients had recurrence. Fifteen percent of patients in group 1 had recurrence and 5% of patients in group 2 had recurrence. There was no recurrence in other groups. There was no significant difference for incisional hernia and the other complications between groups (p = 0.368).ConclusionsThere was no significant difference between the techniques in terms of the development of incisional hernias or complications.

Open Underlay Mesh Reinforced Large Incisional Hernia Repair—Prospective Observational Hospital Based Study

Introduction: Incisional hernias frequently complicate abdominal surgeries with a varied incidence as reported to be 2% - 20%. The risk factors of development of incisional hernias include immunocompromised state, diabetes mellitus, smoking, obesity, wound infection at the index surgery, emergency surgery. Materials and Methods: The study design was prospective and included 62 patients with incisional hernias. The patients were evaluated preoperatively on OPD basis with history, clinical examination, baseline investigation, ultrasound abdomen and computed tomogram. Results: The mean age was 48.9 years with male:female ratio of 1:1.4. Mean BMI was 30.1 kg/m2. Out of 62 patients in the study 61.2% had concomitant hypertension and were on treatment for the same. 30.6% were clinically hypothyroid, 38.7% were diabetic and 54.8% were smokers. There were multiple factors present in patients in the current study which were observed to be possible to have risked the patients to incisional hernias after an abdominal surgery. 21 patients had defect size ranging from 5 to 10 cm and 41 patients were bearing a hernia of the defect size of 10 cm or more. The mean operative time was 221.7 minutes. Conclusion: Incisional hernias are a part of surgical practice that would probably glue to it to the end of time. A progression from primitive suture repair with recurrence rates of over 65% to modern day mesh reinforced repairs with recurrences aimed at 0% is always welcome. But still then the placement of mesh in different positions or layers of abdominal wall yields different results.

Comparison of Two Predictive Scores for the Development of Incisional Hernia

Introduction: Incisional Hernia (IH) is a frequent complication of abdominal surgery, with an incidence of 10-23%, which can increase to 38% in specific risk groups. So far there is no ideal method to identify patients at high risk of developing IH, this variety in the criteria of inclusion of patients in different studies makes is very complicate to compare the results. The aim of this study is comparing the two predictive scores of incisional hernias (Hernia project Vs Van Ramshorst) with higher diagnostic performance and determine which is better to predict IH. Methods: An analytical, observational study was conducted between June and December 2018, in patients of both sexes, who were 18 years or older, undergoing midline laparotomy, regardless of their background diagnosis either urgently or scheduled between 2007 to 2016. The two different classifications, the Hernia Project score and Van Ramshorst score, were applied to each of the patients. With the identification of patients with hernia, two groups, healthy and ill, were performed and Bayesian statistics were made with it and to identify which scale best predicts the presence of this complication. Results: The records of 1085 patients undergoing midline laparotomy were reviewed. 296 patients were ruled out because their follow-up was not complete. Both tests were compared to determine the best diagnostic performance using the ROC curve and the area under the curve, finding that the Hernia Project Score has a larger area 0.724 compared to a 0.663 of Van Ramshorst. Discussion: In our patient cohort, the Hernia Project score has a greater predictive capacity, with an area under the best curve (0.72 vs. 0.66) however both They have a poor sensitivity and this is the main measure of the predictive capacity of any diagnostic test, so with these results, we can affirm that the Project hernia scale has a greater diagnostic capacity than the Van Ramshorst scale but still its diagnostic capacity is limited. Conclusions: Both scores have low sensitivity. We can affirm that the Hernia Project score has a greater diagnostic capacity than the Van Ramshorst score, but both have a limited diagnostic capacity.

Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series.

Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. The vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.

Predictors of incisional hernia in adult liver transplant recipients.

Incisional hernia is a complication following abdominal operation. Patients undergoing liver transplantation have a high risk of developing incisional hernia because of immunosuppression. The purpose of this study was to evaluate incisional hernia after liver transplantation and to identify risk factors for hernia formation in those patients. We retrospectively reviewed 1044 adult patients with more than 2years of follow-up in patients who underwent liver transplantation from January 2000 to December 2015. Incisional hernia was identified in 79 patients with more than 2years of follow-up. The overall incisional hernia rate was 7.6%. The mean age and body mass index (BMI) of the patients with incisional hernia were 55 ± 9years and 25.3 ± 3.7kg/m2, respectively. No significant differences in gender, diagnosis, diabetes, Child-Pugh score, model for end-stage liver disease (MELD) score, donor type, hepatorenal syndrome, varix bleeding, ascites, hepatic encephalopathy, ventilator use, spontaneous bacterial peritonitis (SBP), or bile leakage were found between patients who did and did not develop incisional hernia. Patients with acute rejection before hernia development were more to have herniated patients hernia (p < 0.05). Age greater than 55years and high BMI were significant risk factors. We identified risk factors for the development of incisional hernia. Based on these risk factors, attention should be paid to incisional hernia in older and obese patients.

Sarcomania? The Inapplicability of Sarcopenia Measurement in Predicting Incisional Hernia Development

BackgroundIncisional hernia is a frequent complication after abdominal surgery. A risk factor for incisional hernia, related to body composition, is obesity. Poor skeletal muscle mass might also be a risk factor, as it may result in weakness of the abdominal wall. However, it remains unknown if sarcopenia (i.e. low skeletal muscle mass) is a risk factor for incisional hernia. Therefore, this study aims to investigate whether a relation between sarcopenia and incisional hernia exists.MethodsPatients from the STITCH trial, who underwent elective midline laparotomy, were included. Computed tomography examinations performed within 3 months preoperatively were used to measure the skeletal muscle index (SMI; cm2/m2). Primarily, SMI measured continuously, sarcopenia based on previously described cut-off values for the SMI, and sarcopenia as the lowest gender-specific SMI quartile were assessed as measures to predict incisional hernia occurrence. Secondary, the association between these three measures and post-operative complications was investigated.ResultsIn total, 283 patients (45.2% male; mean age 63.7 years; mean BMI 25.36 kg/m2) were included, of whom 52 (18%) developed an incisional hernia. Mean SMI was 44.23 cm2/m2 (SD 7.77). The Nagelkerke value for the three measures of sarcopenia was about 0.020 (2.0%) for incisional hernia development. Logistic regressions with the three measures of sarcopenia did not show any predictive value of the model (area under the curve (AUC) of 0.67 for incisional hernia; 0.69 for post-operative complications).DiscussionIn this study, sarcopenia does not seem to be a risk factor for the development of an incisional hernia.

Recent Therapeutic Alternative Methods for Burst Abdomen and its Relation to Development of Incisional Hernia

Background: Burst abdomen is considered one of the most challenging obstacles that facing general surgery. Studying the layers of the abdominal wall, and knowing the anatomy of the anterior abdominal wall, its arterial and nerve supply is the corner stone in management of that surgical problem, and in finding the best way how to close that defect. Objective: The aims of the study were to evaluate and compare between recent therapeutic methods of burst abdomen after elective and emergency laparotomy as regard technical, function and to prevent its complication with its later development of incisional hernia. Patients and Methods: This randomized prospective study was carried out at Al-Azhar University Hospitals and Military production hospital on 20 patients with post-lapraotomy burst abdomen in the period from January 2016 to October 2017. The patients were randomly classified according to the method of abdomen closure into 5 groups; 4 patients each: Group A: Closure with TI, TIE, TIES incisions and component separation technique. Group B: Simple mass closure with continuous sutures. Group C: Closure using a Pedicled Tensor Fascia LataFlap. Group D: Vacuum assisted closure. Group E: Closure with gradual skin stretching by tension relief system(TRS). Results: By the use of TI, TIE, TIES incisions and component separation technique, complete fascial closure was achieved in 3 patients (75%).By the use of mass closure, complete fascial closure was achieved in all patients (100%).By the use of the vacuum assisted closure, complete fascial closure was achieved in all patients (100%) but enterocutaneous fistula was encountered in one patient (25%). By the use of the pedicled tensor fascia lata to close the abdomen, complete fascial closure was achieved in all patients (100%) but recurrence occurred in one patient (25%).By the use of the TRS, complete fascial closure was achieved in 2 patients (50%) Conclusion: Mass closure with continous suture seems to be the best method as the abdominal wall defect is not large as its simple ,easy and cost effective .

Incisional Hernia Development after Pancreatic Resections

Incisional Hernia Development after Pancreatic Resections

Recent Therapeutic Alternative Methods for Burst Abdomen and its Relation to Development of Incisional Hernia

Recent Therapeutic Alternative Methods for Burst Abdomen and its Relation to Development of Incisional Hernia

Interrupted versus continuous fascial closure in patients undergoing emergent laparotomy: A randomized controlled trial.

The optimal method of fascial closure, interrupted fascial closure (IFC) versus continuous fascial closure (CFC) has never been studied exclusively in the setting of emergency surgery. We hypothesized that IFC decreases postoperative incisional hernia development following emergent laparotomies. Between August 2008 and September 2015, patients undergoing emergent laparotomies were consented and randomly assigned to either IFC or CFC. Patients were followed up postoperatively for at least 3 months and assessed for incisional hernia, dehiscence, or wound infection. We excluded those with trauma, elective surgery, mesh in place, primary ventral hernia, previous abdominal surgery within 30 days, or those not expected to survive for more than 48 hours. Our primary endpoint was the incidence of postoperative incisional hernias. One hundred thirty-six patients were randomly assigned to IFC (n = 67) or CFC (n = 69). Baseline characteristics were similar between the groups. No difference was noted in the length of the abdominal incision, or the peak inspiratory pressure after the closure. The median time needed for closure was significantly longer in the IFC group (22 minutes vs. 13 minutes, p < 0.001). Thirty-seven (55.2%) IFC and 41 (59.4%) CFC patients completed their follow-up visits. There was no statistically significant difference in baseline and intraoperative characteristics between those who completed follow-ups and those who did not. The median time from the day of surgery to the day of the last follow-up was similar between IFC and CFC (233 days vs. 216 days, p = 0.67), as were the rates of incisional hernia (13.5% versus 22.0%, p = 0.25), dehiscence (2.7% vs. 2.4%, p = 1.0), and surgical site infection (16.2% vs. 12.2%, p = 0.75). There was no statistically detectable difference in postoperative hernia development between those undergoing IFC versus CFC after emergent laparotomies. However, this may be due to the relatively low sample size. Therapeutic/Care Management Study, level III.