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. 2018 May 23:5:34.
doi: 10.3389/fsurg.2018.00034. eCollection 2018.

Abdominal Wall Closure in Elective Midline Laparotomy: The Current Recommendations

René H Fortelny  1   2
Affiliations

Abdominal Wall Closure in Elective Midline Laparotomy: The Current Recommendations

René H Fortelny. Front Surg. .

Abstract

Introduction: The risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent. The goal of this systematic review was to evaluate different closure techniques for midline laparotomies and the use of additional prophylactic mesh augmentation for midline closure in high risk patients.

Method: A systematic literature search was performed until September 2017. The quality of the RCTs was evaluated and analysed. The data are reported in accordance with the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results: In the systematic review for closure techniques a total of 23 RCTs and 9 RCTs for the use of prophylactic mesh were included. In elective midline closure the use of a slowly absorbable suture material for continuous closure using the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). The use of prophylactic mesh versus the suture closure of the midline achieved a significant reduction of the incisional hernia rate [OR 0.14 (95% CI 0.07-0.27)].

Conclusions: Based on the currently evidence in midline closure after elective laparotomy in the small bites technique can be recommended to reduce significantly the rate of incisional hernia. The additional use of a prophylactic mesh in high risk patients can significantly reduce the occurrence of incisional hernia.

Keywords: incisional hernia; midline closure; prevention; prophylactic mesh; small bite technique.

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Figures

Figure 1
Figure 1
"Button holes" due to high tension aftermidline closure by large bite technique using a loop suture (blue arrows).
Figure 2
Figure 2
Comparison of loop suture (USP 1 with HR 48 needle) and single suture (USP 2/0 with HR 26 needle).
Figure 3
Figure 3
Characteristics of "small bites" technique.
Figure 4
Figure 4
Small bites/stitch technique.
See this image and copyright information in PMC

References

    1. van 't Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J, Friedman DW. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg (2002) 89(11):1350–6. 10.1046/j.1365-2168.2002.02258.x - DOI - PubMed
    1. Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, et al. Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg (1993) 218(6):754–60. 10.1097/00000658-199312000-00009 - DOI - PMC - PubMed
    1. Usher FC. Technique for repairing inguinal hernias with Marlex mesh. Am J Surg (1982) 143(3):382–4. 10.1016/0002-9610(82)90113-1 - DOI - PubMed
    1. Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg (1997) 163(3):175–80. - PubMed
    1. Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg (1993) 80(10):1284–6. 10.1002/bjs.1800801020 - DOI - PubMed

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