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Review
. 2023 Dec 1:2:12159.
doi: 10.3389/jaws.2023.12159. eCollection 2023.

Educating Residents in Abdominal Wall Closure: An Overview

Justin Leavitt  1 , Matthew Hager  1 , Colston Edgerton  1 , W Borden Hooks 3rd  1 , William Hope  1
Affiliations
Review

Educating Residents in Abdominal Wall Closure: An Overview

Justin Leavitt et al. J Abdom Wall Surg. .

Abstract

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.

Keywords: closure; education; hernia; laparotomy; prevention; resident; simulation.

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Conflict of interest statement

WH has received speaker fees/honorarium from BD, WL Gore, Intuitive, Medtronic, and Allergan. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Small-bite technique of fascial closure using running polydioxanone (PDS) suture.
FIGURE 2
FIGURE 2
Measuring suture remainder after fascial closure to calculate suture to wound length ratio.
FIGURE 3
FIGURE 3
Abdominal wall model with layers of the wall represented by felt with different thickness and characteristics, providing an affordable model for fascial closures and plane development.
FIGURE 4
FIGURE 4
This piece of felt was secured to a wooden frame with a “midline” incision to evaluate the time it took residents to run a simulated fascial closure using 5 mm bites with 5 mm travel. The bite-size and travel distance were measured and analyzed for accuracy.
FIGURE 5
FIGURE 5
Fascial closure with approximately 5 mm bites and 5 mm travel.
See this image and copyright information in PMC

References

    1. Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS ONE (2015) 10(9):e0138745. 10.1371/journal.pone.0138745 - DOI - PMC - PubMed
    1. Holihan JL, Alawadi Z, Martindale RG, Roth JS, Wray CJ, Ko TC, et al. Adverse Events After Ventral Hernia Repair: The Vicious Cycle of Complications. J Am Coll Surgeons (2015) 221(2):478–85. 10.1016/j.jamcollsurg.2015.04.026 - DOI - PubMed
    1. Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, et al. Updated Guideline for Closure of Abdominal Wall Incisions From the European and American Hernia Societies. Br J Surg (2022) 109(12):1239–50. 10.1093/bjs/znac302 - DOI - PMC - PubMed
    1. Fischer JP, Harris HW, López-Cano M, Hope WW. Hernia Prevention: Practice Patterns and Surgeons’ Attitudes About Abdominal Wall Closure and the Use of Prophylactic Mesh. Hernia (2019) 23(2):329–34. 10.1007/s10029-019-01894-z - DOI - PubMed
    1. Pereira Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser JJ, Pera-Román M, et al. Small Bites Technique for Midline Laparotomy Closure: From Theory to Practice: Still a Long Way to Go. Surgery (2021) 170(1):140–5. 10.1016/j.surg.2020.12.007 - DOI - PubMed