Abdominal Closure Techniques Research Articles

BHSo6 A systematic review and meta-regression of factors affecting incisional hernia rates in midline incisions over a 10 year period

Abstract Aims Incisional hernia (IH) rates in midline incisions have been reported to be 12.8% in a systematic review of literature published in 2015. With updated guidance on abdominal wall closure techniques, the landscape of abdominal wall closure has changed. We aimed to update this literature to assess changes in both rates and risk factors for IH in midline incisions. Methods We undertook a systematic review of literature according to PRISMA guidelines and registered on PROSPERO. All papers reporting IH rates in midline incisions with primary suture closure between April 2013-October 2022 were included. Papers with two or more arms suitable for inclusion were extracted independently. Results Sixty three papers (21 RCTs, 36 cohort studies and 6 case-control studies), comprising 18 126 patients were included. The mean IH rate was 16.8% at a weighted mean follow up of 31.3 months. There was no significant increase in IH rates over time. Meta-regression identified two study level variables that correlated with an increase in IH rates (Use of radiology for diagnosis of IH and inclusion of patients undergoing a contaminated procedure) and one operative variable that corresponded with a decrease in rates (Small bites closure technique). Conclusions Incisional hernia rates have increased in midline incisions. Study level characteristics account for the majority of risk, suggesting standardisation of trial technique is aiding in IH detection. Small bites technique is associated with a significant reduction in IH rates, and future work should focus on strengthening the evidence base around this technique.

Prevention of Burst Abdomen by Interrupted Midline Fascial Closure in Emergency Laparotomy

Background: Burst abdomen represents one of the most frustrating and difficult postoperative complication that concerns every abdominal surgeon. It occurs because of various predisposing factors which can be prevented to some extend by having knowledge regarding them. Despite many years of experience, the optimal technique of emergency laparotomy closure remains more or less controversial. The varieties of surgical excess as well as the varieties of abdominal closure techniques are the main difficulties in the proper standardization of this procedure. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing emergency laparotomy that can reduce the burden of complications in post-operative period. Materials and methods: A total of 260 patients of acute abdominal condition who underwent laparotomy were randomized into two groups of 130 patients in each group. Results: Total 19(7.30%) of 260 patients developed burst abdomen in the post- operative period. Twelve 12(9.23%) in continuous arms and seven 7(5.34%) patients in interrupted arms developed burst abdomen. Burst abdomen occurring mostly 40-60 years of age group with a male to female ratio 1.48:1. Predictor Variables: Cough, anemia, malnutrition, DM, intraperitoneal Sepsis, wound infection, uremia and abdominal distension were the important predisposing factors for the incidence of burst abdomen. Conclusion: Interrupted suturing was associated with significantly reduced the burst abdomen when comparing with continuous closure.

A study to compare abdominal wall closure with interrupted vs. continuous sutures using polydioxanone in patients undergoing emergency exploratory laparotomy

Background: Wound closure in emergency surgeries can be done either by interrupted or by continuous sutures with each having its own advantages and disadvantages. In this paper we shall try to compare the advantages and adverse effects of both these methods of wound closure. Methods: A prospective comparative study involving 50 patients undergoing emergency laparotomies was conducted in Department of General Surgery, MMIMSR, Mullana from October 2022 to April 2024 (18 months). We compared two abdominal wall closure techniques using polydioxanone (PDS), patients, aged 18-75 years, were alternatively assigned to one of two groups: Group I received interrupted PDS sutures, while Group II received continuous PDS sutures. Postoperatively, pain and complications like infections were observed and analysed statistically. Results: In our study, we compared abdominal wall closure techniques in emergency exploratory laparotomy patients. The mean age was similar in the two groups, 43.68 years vs 43.08 years respectively in group I and II. Wound infection occurred in 44% of patients in the interrupted suture group and 60% in the continuous suture group, with a significant difference favouring the interrupted method. The mean wound closure time (33.24 vs 18.32 minutes) and post operative pain were more in the interrupted suture group as compared to the continuous suture group. Conclusions: The interrupted suturing method proved to be more effective in preventing complications, it did require more time to perform. However, after thoroughly reviewing the available data, no definitive evidence was found to support the superiority of either techniques.

Comparison of continuous versus modified continuous SMEAD jones “far-near-near-far” suturing technique for abdominal wall closure in emergency midline laparotomy wound in terms of wound dehiscence.

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method.

Advances and Techniques in Subcuticular Suturing for Abdominal Wall Closure: A Comprehensive Review.

Subcuticular suturing has emerged as a prominent technique for abdominal wall closure, offering notable benefits in cosmetic outcomes, infection reduction, and patient satisfaction. This comprehensive review delves into the evolution and current state of subcuticular suturing, examining its principles, techniques, and advancements. Traditional methods like continuous and interrupted suturing are compared with modern innovations like barbed sutures and knotless techniques. Clinical outcomes, including healing efficacy, complication rates, and cost-effectiveness, are analyzed to highlight the technique's advantages. The review also explores specific applications in various surgical specialities, presenting case studies and clinical trials to substantiate its effectiveness. Despite certain challenges and limitations, the future of subcuticular suturing appears promising with ongoing research and technological advancements. This review aims to thoroughly understand subcuticular suturing, emphasizing its significance in improving surgical outcomes and patient care in abdominal wall closure.

Photo-crosslinking modified gelatin-silk fibroin hydrogel for accelerating wound repair of open abdomen

Open abdomen (OA), a major advance in modern trauma surgery, enables the treatment of severe abdominal trauma, infections, and hypertension by temporarily closing the abdominal cavity without suturing. Although OA can reduce mortality rates, it also presents challenges such as disruption of the abdominal environment, intestinal exposure, and impaired wound healing. Current temporary abdominal closure (TAC) techniques using polypropylene (PP) mesh are susceptible to abrasion and rupture of the intestine, leading to adhesions and serious complications such as intestinal fistulas and chronic wounds. These complications seriously impact outcomes due to mesh rigidity and its incompatibility with surrounding tissues. In this study, we designed a multifunctional hydrogel composed of GelMA (Gelatin Methacryloyl) and SilMA (Silk Fibroin Methacryloyl) as a promising solution for open abdominal wound repair. In vitro experiments confirmed the biocompatibility, self-healing properties, pro-angiogenic effects, and promotion of macrophage polarization. In vivo studies revealed that the GelMA-SilMA hydrogel could enhance abdominal wall tissue thickness and integrity via isolating the peritoneal cavity, protecting the intestinal tract, polarizing macrophages, promoting collagen formation, inducing neovascularization, inhibiting oxidative stress, and suppressing inflammation. Furthermore, immunofluorescence, immunohistochemistry, and RNA sequencing were employed to evaluate the wound healing mechanisms of GelMA-SilMA hydrogels. The results demonstrated that the hydrogels can promote angiogenesis, inhibit inflammation and immune responses, and enhance wound healing by activating the HIF-a-VEGF signaling pathway, RAP1 signaling pathway, and PI3K-AKT signaling pathway. Hence, the multifunctional GelMA-SilMA hydrogel has tremendous potential for clinical use in open abdominal wound repair.

Management of open abdomen with enteroatmospheric fistulas: A retrospective analysis of 191 cases

Background: This study investigates the management of open abdomen, a significant advancement in abdominal damage control surgery essential for treating severe trauma, intra-abdominal infections, and abdominal compartment syndrome. However, challenges such as fluid loss, electrolyte imbalances, failures in primary fascial closure, and the development of enteroatmospheric fistulas remain prevalent. Methods: This observational research retrospectively analyzed clinical data from 191 patients with open abdominal cavities and enteroatmospheric fistulas admitted to the Department of General Surgery, Jinling Hospital, between January 2012 and January 2021. This study collected and analyzed baseline patient data, including age, gender, body mass index (BMI), primary disease. The study compared two groups based on temporary closure methods: Skin-implant and skin-suture-only. Results: This analysis revealed that 81.7% of the 191 patients included in the final analysis were male, with an average age of 46.5 years and a BMI of 21.7 kg/m2. The primary diseases were predominantly trauma, gastrointestinal tumors, gastrointestinal perforations, intestinal obstructions, and acute pancreatitis. Various methods for fistula closure and temporary abdominal closure techniques were employed, with abdominal wall defects repaired using the component separation technique or biological patches. Conclusion: These findings underscore the complexity of managing open abdomen cases with enteroatmospheric fistulas, highlight the importance of early intervention and appropriate temporary closure techniques for achieving optimal outcomes, and offer valuable insights into the diagnosis and treatment of enteroatmospheric fistulas.

A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery

BackgroundTemporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital.MethodsA retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles.ResultsA total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3–3.8, p < 0.05).ConclusionIn patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.

A SYSTEMATIC REVIEW AND META-REGRESSION OF FACTORS AFFECTING INCISIONAL HERNIA RATES IN MIDLINE INCISIONS OVER A 10-YEAR PERIOD

Abstract Aims The Incisional hernia (IH) rate after midline incisions was reported to be 12.8% in a systematic review of literature published in 2015. With updated guidance on abdominal wall closure techniques, the landscape of abdominal wall closure has changed. We aimed to update this literature to assess any change in the rates and any new identifiable risk factors for IH in midline incisions. Methods We undertook a systematic review of literature according to PRISMA guidelines and registered on PROSPERO. All papers reporting IH rates in midline incisions with primary suture closure between April 2013 — October 2022 were included. Papers with two or more arms suitable for inclusion were extracted independently. Results Sixty three papers (21 RCTs, 36 cohort studies and 6 case-control studies), comprising 18,126 patients were included. The mean IH rate was 16.8% at a weighted mean follow up of 31.3 months. Meta-regression identified two study level variables that correlated with an increase in IH rates (Use of radiology for diagnosis of IH and inclusion of patients undergoing a contaminated procedure) and one operative variable that corresponded with a decrease in rates (Small bites closure technique). Conclusions The Incisional hernia rate in midline incisions reported in the literature have increased over the last decade. A change in detection method and an increase in patient complexity may account for the majority of risk, suggesting standardisation of trial technique is essential in IH prevention trials. Small bites technique is associated with a significant reduction in IH rates, and future work should focus on strengthening the evidence base around this technique.

Hughes Abdomen Closure Technique Versus Continuous Closure in Emergency Midline Laparotomy: A Randomized Controlled Study.

Background Abdominal wound dehiscence, a serious postoperative issue, remains a significant concern for surgeons due to its potential to increase patient mortality and morbidity. Disruption can occur at any point after surgery, sparking debate over the optimal closure method for midline vertical abdominal wounds. Therefore, it's crucial to determine the safest approach. Our randomized clinical trialis plannedtocompare the risk of a burst abdomen associated with the Hughes abdominal closure technique to that of continuous abdominal closure. Methods All patients >18 years scheduled for emergency midline laparotomy were randomly assigned into two groups using computer-generated random numbers: Group A underwent Hughes repair (12 patients) and Group B underwent continuous closure(17 patients). Preoperative data, including patient demographics, and postoperative outcomes, such as time for rectus closure, wound dehiscence, surgical site infection (SSI), and length of hospital stay, were documented for analysis. Results The study found that the average patient age was 37.89 years, with more males than females. Both groups had an equal distribution of co-morbidities (p = 0.468), but none of these factors were statistically significant. Burst abdomen occurred in 25% of group A and 41.1% of group B (p = 0.367, not significant). Incisional hernia was absent in both groups. Surgical site infection (p = 0.119) and respiratory complications (p = 0.16) were not statistically significant between groups. However, in group A, theregressive analysis showed significant associations between burst abdomen, surgical site infection (p = 0.018), and respiratory complications (p = 0.007), whilein group B, these associations were not significant (p = 0.252 for SSI and p = 0.906 for respiratory complications). Conclusion The occurrence of burst abdomen and closure time differences between continuous and Hughes techniques were not significant. The Hughes technique was quicker to learn (32 vs. 22 minutes). Burst abdomen was more common in continuous closure (group A: 25% vs. group B: 41%), favoring the Hughes technique. Factors like age, gender, and others didn't significantly impact the burst abdomen in either group.

COMPARISON OF POST-OPERATIVE OUTCOMES OF MASS CLOSURE CONTINUOUS TECHNIQUE VS HUGHES REPAIR IN PATIENTS UNDERGOING EXPLORATORY LAPAROTOMY

Surgical techniques for abdominal closure following exploratory laparotomy play a crucial role in determining postoperative complications. The mass closure continuous approach and Hughes repair are commonly employed methods with unique characteristics and outcomes. Objective: This retrospective comparative study aimed to evaluate the incidence of postoperative complications associated with the mass closure continuous approach and Hughes repair in patients undergoing exploratory laparotomy. Methods: The study was conducted at Nishtar Hospital Multan from July 2023 to December 2023. A total of 50 patients aged between 18 and 60 years of both genders, undergoing exploratory laparotomy, were included through non-probability sampling. Patients were treated either with the mass closure continuous technique or Hughes repair for abdominal closure. The mean operative time for each technique was recorded. The incidence of postoperative complications, including incisional hernia, wound infection, abdominal burst, and seroma, was assessed. Statistical analysis was performed using appropriate methods. Results: The mean operative time for the mass closure continuous technique was 16.32±2.1 minutes, significantly lower than that of Hughes repair (p&lt;0.0001). Patients treated with Hughes repair demonstrated a significantly lower incidence of incisional hernia, wound infection, abdominal burst, and seroma compared to those treated with the mass closure continuous technique. Conclusion: Hughes's repair technique for abdominal closure following exploratory laparotomy is associated with reduced occurrence of postoperative complications, including incisional hernia and wound-related issues. Therefore, it may be considered a safe and effective option for abdominal closure in these patients.

Anterior component separation technique for abdominal wall closure among patients undergoing colorectal surgery: Short-term outcomes and initial experience

IntroductionThe anterior component separation (ACS) is a technique used for abdominal wall closure performed by dissecting and medially advancing the musculature to achieve tension-free closure. Methodsand Materials:This study reviewed our experience with this procedure as used for complex abdominal wall defects encountered during colorectal surgery in a 7-year period. ResultsSixteen patients were included, with 12 having malignancies and the rest for infectious or inflammatory conditions. Defects ranged from 16–400 cm2 and were mostly located at the midline (56%, n = 9). Five cases required additional flaps for closure, attributed either to the size or area of abdominal involvement where benefits of component separation is more limited. Complications include surgical site infection (n = 4), hematoma (n = 2), seroma (n = 1), and wound dehiscence (n = 2). None required ICU admission or assisted ventilation post-operatively. One patient died who had a preexisting cardiac pathology, and the rest were discharged improved. ConclusionThis study demonstrates use of this modality for autologous reconstruction of complex appropriately sized abdominal wall defects from multiple etiologies. Adjunct flaps may be used to achieve reconstruction particularly in areas wherein the effectiveness of ACS is limited. While the study is able to describe immediate outcomes, long-term follow-up is recommended.

Mesh or No Mesh? A Systematic Review of Abdominal Donor-Site Closure Techniques and Morbidity after DIEP Flap Breast Reconstruction

Mesh or No Mesh? A Systematic Review of Abdominal Donor-Site Closure Techniques and Morbidity after DIEP Flap Breast Reconstruction

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.

Author response to: Comment on: Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial.

Author response to: Comment on: Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial.

An injectable, self-healable, antibacterial, and pro-healing oxidized pullulan polysaccharide/carboxymethyl chitosan hydrogel for early protection of open abdominal wounds

Open abdomen (OA) is an effective method for treating critical abdominal conditions such as severe abdominal infections. The temporary abdominal closure (TAC) technique is often used to temporarily restore the physiological environment of the abdominal cavity and maintain the homeostatic balance of the abdominal cavity. However, most of the common TAC materials available today lack bio-responsiveness, tend to abrade the intestinal canal, and lead to delayed tissue healing of the wound. Hydrogels could mimic the extracellular matrix and have shown significant potential in life science fields such as tissue regeneration, wound repair, and controlled drug release. In this study, a composite hydrogel scaffold was constructed by the Schiff base reaction of oxidized pullulan polysaccharide with carboxymethyl chitosan. The hydrogel exhibited excellent self-healing, cellular biocompatibility, and antibacterial and anti-inflammatory abilities, and in experiments it reduced secondary damage caused by friction between tissue and patch, thereby preventing serious complications such as intestinal fistula, promoted M1–M2 polarization of macrophages, reduced the inflammatory response, regulated the inflammatory microenvironment in vivo, promoted angiogenesis and granulation tissue regeneration, and accelerated wound healing. Therefore, our hydrogel provides a new strategy for material-assisted wound protection during OA and has potential clinical applications.

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.

Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure.

This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology.

The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI). An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices. A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n= 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n= 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice. Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements.

Open abdomen: a comprehensive review

When the abdominal viscera are visible due to a defect in the abdominal wall, which is usually caused intentionally or as a result of abdominal compartment syndrome, it is referred to as an open abdomen. As a protracted open abdomen can result in problems including fluid and protein losses, intestinal fistulization, and loss of abdominal dominance, the main goals of temporal abdominal closure techniques are to prevent fluid losses and loss of dominance. There are several techniques for short-term abdominal closure, each having advantages and disadvantages. These techniques include patch closure, silo closure, and negative pressure systems based on towels and sponges. After temporary abdominal closure, the patient is monitored in the critical care unit while any required adjustments are made to the abdominal dressings. Observational studies have shown that the Wittmann Patch has the highest average rate of primary fascial closure when compared to other operations. Yet, a temporary closure of this sort might not be adequate to stop fluid loss on its own. To monitor fluid loss, a negative pressure device (sponge- or towel-based) is advised. It can be used either on its own or in combination with other techniques for closing the temporal abdominal cavity. When the sign of an open abdomen has been removed, the abdomen is closed, ideally using a major fascial closure. If primary fascial closure cannot be achieved, functional closure may be accomplished using a biological mesh inlay method. While there is a good probability of developing a posterior hernia, this treatment adds new fascial tissue where the natural fascial limits are located. The fascia defect may be filled in with primary skin closure or skin grafts once a layer of granulation tissue has developed over the consolidated visceral mass if the space between the fascia's borders is too large for functional closure. Effective abdominal closure and the prevention of issues ultimately depend on proper management and supervision of temporary abdominal closure.