Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications

Patel, Sunil V.; Paskar, Dave; Nelson, Richard L.; Vedula, Satyanarayana S; Steele, Scott R.

doi:10.1002/14651858.cd005661.pub2

Cited by 94 publications

(94 citation statements)

References 96 publications

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“…Average time for mass closure (20 minutes) was considerably less as compared to layered closure (35 min). 17 Similar conclusions were also reported by the authors such as Chalya et al and Patel et al 18,19 Finally the analysis of complications in studied patients showed that out of 30 patients in group A (layered sutures) 11 (36.67%) patients developed complications and most common complication was found to be wound infection and wound gaping which was seen in 3 (10%) patients each. In group B hematoma, surgical site infection and incision hernia was seen in 1 patient (3.33%) each.…”

Section: Discussionsupporting

confidence: 79%

Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

Euvalingam

Nathan

2019

Int Surg J

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Background: Layered closure of the abdomen has been considered to be ideal until recently however single layer mass (retention) closure technique, in which all the layers of the abdominal wall are closed in single layer is being increasingly used by surgeons. We conducted this study to analyze outcome measures in patients in whom wound closure was done by retention closure and layered closure.Methods: This was a prospective comparative study in which 60 patients undergoing elective or emergency laparotomy were included on the basis of a predefined inclusion and exclusion criteria. In 30 cases (50%) layer closure was done whereas in remaining 30 (50%) patients retention closure technique was used. Major outcome measures studied were time required for wound closure and post-operative complications.Results: Out of 60 studied cases there were 42 (70%) males and 18 (30%) females with M: F ratio of 1: 0.42.The time required for closure in layered suture group (group A) was 26.76±3.36 whereas in case of retention closure suturing it was 19.36±4.35. The difference was found to be statistically highly significant (p<0.0001). The complications rates were found to be statistically significantly higher in layer suturing (Group A) as compared to retention suture group (Group B).Conclusions: We conclude that retention suturing is preferable as compared to layered suturing in patients undergoing midline laparotomy in terms of time required for closure of wound and post-operative complication rates.

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Section: Discussionsupporting

confidence: 79%

Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

Euvalingam

Nathan

2019

Int Surg J

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“…Surgical techniques may be able to reduce the SSI rate, and ideal approaches have long been examined, including antimicrobial suture and methods of abdominal closure . However, these previous reports have focused on open colorectal surgery, and there are few reports of risk factors for incisional SSI with laparoscopic colorectal surgery (Lap CR).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery

Chida

Watanabe

Suwa

et al. 2019

Annals of Gastroent Surgery

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Background Surgical site infection (SSI) is a common morbidity in patients undergoing colorectal surgery, and the focus of previous studies has primarily been on incisional SSI. Most reports thus far have focused on open surgery rather than on laparoscopic colorectal surgery (Lap CR). Therefore, the aim of the present study was to identify the risk factors for incisional SSI in patients undergoing elective Lap CR. Methods This retrospective study was conducted to evaluate the occurrence and risk factors of incisional SSI for elective Lap CR. From January 2008 to June 2018, 1825 consecutive patients with a preoperative diagnosis of colorectal cancer who underwent Lap CR were analyzed at a single institution. Results Incidence of incisional SSI was 3.3%. Postoperative hospital stay (days) was significantly longer in the incisional SSI group than in the non‐incisional SSI group (8 [6‐12] vs 10 [8‐19], P < 0.001). Incisional SSI were significantly associated with five operative factors: blood loss (g) (P < 0.014), midline wound length (mm) (P = 0.038), suture materials (P = 0.014), suture technique (interrupted vs continuous mass closure, P = 0.003), and organ/space SSI (P = 0.041). Multivariate analysis showed that continuous mass closure (odds ratio 0.290; 95% confidence interval 0.101‐0.831, P = 0.021) was the only factor independently associated with the incidence of incisional SSI. Conclusions Incidence of incisional SSI was comparable to that in previous reports. Continuous mass closure decreased the risk of incisional SSI in elective Lap CR.

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“…Despite the rise of laparoscopic surgery, open abdominal surgery by a midline laparotomy is still the most performed approach in abdominal surgery today (35). Regardless of improvements in the surgical techniques of abdominal wall closure, IH incidence remain high and cause substantial morbidity and costs (24).…”

Section: Discussionmentioning

confidence: 99%

Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

Heger

Feißt

Krisam

et al. 2019

Preprint

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Background: Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques the risk for developing an incisional hernia is reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods: The HULC trial is a multicentre randomized controlled, observer and patient blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in onlay technique. The primary endpoint will be the occurrence of incisional hernias as defined by the European Hernia Society within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion: The HULC trial will address the yet unanswered question whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

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Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications

Abstract: Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications (Review)

Cited by 94 publications

References 96 publications

Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery

Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

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