Early laparotomy wound failure as the mechanism for incisional hernia formation

Abstract

Background Incisional hernia is the most common complication of abdominal surgery leading to reoperation. In the United States, 200,000 incisional hernia repairs are performed annually, often with significant morbidity. Obesity is increasing the risk of laparotomy wound failure. Methods We used a validated animal model of incisional hernia formation. We intentionally induced laparotomy wound failure in otherwise normal adult, male Sprague-Dawley rats. Radio-opaque, metal surgical clips served as markers for the use of x-ray images to follow the progress of laparotomy wound failure. We confirmed radiographic findings of the time course for mechanical laparotomy wound failure by necropsy. Results Noninvasive radiographic imaging predicts early laparotomy wound failure and incisional hernia formation. We confirmed both transverse and craniocaudad migration of radio-opaque markers at necropsy after 28 d that was uniformly associated with the clinical development of incisional hernias. Conclusions Early laparotomy wound failure is a primary mechanism for incisional hernia formation. A noninvasive radiographic method for studying laparotomy wound healing may help design clinical trials to prevent and treat this common general surgical complication.

In Vivo Evaluation of a Novel Mesh Suture Design for Abdominal Wall Closure

“…1–5 However, the most significant innovation would be one that effectively prevents the laparotomy failure that drives incisional hernia formation. 6 Over the past 3000 years, sutures used to oppose divided tissues have changed little from their initial flexible linear design. 7 Also unchanged during that time is the problem of suture pull-through.…”

Comparación de dos técnicas de sutura para cierre aponeurótico en laparotomía media en pacientes con alto riesgo de evisceración posquirúrgica

“…Descripción del proceso 1. Al paciente se le programa para cirugía de forma electiva o urgente, y se le aplica la escala de Van Ramshorst.…”

“…La evisceración se considera la etapa aguda de la hernia incisional, principal complicación posterior a una laparotomía media, cuya reparación es, a su vez, la causa principal de reoperación en estos pacientes 1 , cuya incidencia es del 12-15 % de todas las laparotomías efectuadas de manera programada, alcanzando hasta el 40 % en casos urgentes y en pacientes de alto riesgo 2 .…”

Surgical mesh for ventral incisional hernia repairs:Understanding mesh design

“…The integrity of the repair is dependent on suture fixation until the load-bearing properties of the scar become equal to or surpass that of the suture. The fundamental pathophysiology of ventral incisional hernia is lateral migration of the rectus muscle with loss of function commonly referred to as 'loss of domain' (14). Mesh has become standard for repair of incisional hernias because it mitigates loss of domain and helps maintain the rectus muscles in the midline where they function best.…”