Müssen wir den Bauchdeckenverschluss neu erlernen?

Abstract

The 1‑year incisional hernia rate of 9-30 % has been tolerated for decades. Even in the 1970s and 1980s there was evidence that supported reducing suture tension. Recently, the traditional 4:1 relationship between suture and wound length, which has been passed on for years, has been questioned. After first experimental and clinical data suggested an advantage by reducing the width and interval of stitches by 50 %, the prospective randomized STITCH study has now provided evidence by significantly lowering the 1‑year hernia rate from 21 % to 13 %. For surgeons this means less of a revolution and more of an innovative evolution of a long-established technique. Before introduction of the technique quality assurance must be carried out with documentation of performance indicators (e.g. number of stitches, length of thread incorporated and wound length).

Continuous and interrupted abdominal-wall closure after primary emergency midline laparotomy (CONIAC-trial): study protocol for a randomised controlled single centre trial

“…The incidence of incisional hernias 1 year after surgery is around 9%-20%, 1 2 but can rise up to over 35% in patients with risk factors. 3 This represents a major health and social problem. An incisional hernia is often associated with pain and limitations in professional life.…”

Paradigmenwechsel beim Bauchdeckenverschluss?

“…Erfreulicher muten die Daten des Statistischen Bundesamts an, in denen die Narbenhernienrate ihr Maximum möglicherweise bereits überschritten hat [2]. Die Zeichen mehren sich, dass in der Summation präventive Maßnahmen der chirurgischen Versorgung zu einer Umkehr der scheinbar stetig steigenden Zahlen beigetragen haben.…”