Faszienheilungsm�glichkeiten und Platzbauch

Abstract

The difficulties of acute or delayed failure of fascial healing after laparotomies are of great socioeconomic relevance. Despite a plurality of publications in the last decades, the incidence of burst abdomen (1-3%) and incisional hernia (10-15%) remained unchanged. The generally accepted cause is a multifactorial event with a large number of influencing factors. Therefore, only interdisciplinary cooperations are a match for the scientific complexity of this topic. A still underestimated problem is the description of wound healing factors influencing the microclimate in fascial healing. New aspects of pharmacotherapy and better understanding of collagen synthesis and dynamics of closure tension might improve the clinical situation in the future.

Surgery for Body Packing in the Caribbean: A Retrospective Study of 70 Patients

“…Fascia dehiscence after laparotomy can be associated with wound infection, emergency surgery, problems in perioperative oxygenation, hypothermia, hypoproteinemia, anemia, technical faults, or increased intra-abdominal pressure. In our study the percentage of fascia dehiscence of 2.9% (Table 2) is not very different from the 1%-3% reported after other abdominal surgery [29][30][31].The constitution of our study cohort, consisting primarily of young adults with a well-defined, strong abdominal fascia is a possible explanation for the low rate of fascia dehiscence compared to the high rate of wound infection. In addition there was no significant correlation between fascia dehiscence and the localization or type of surgical procedure, only a statistically non-significant tendency toward a positive correlation with duodenotomy (p = 0.06).…”

Chirurgische Durchtrennung und Verschluss der Bauchdecke

“…Die untersuchten Patientengruppen sind allerdings zu klein, um selbst bei einer erwarteten Narbenhernienrate von 15% eine statistisch signifikante Aussage zu machen. Ein isolierter Verschluss des Peritoneums leistet keinen Beitrag zur mechanischen Festigkeit des Laparotomieverschlusses [6]. Des Weiteren kann unserer Ansicht nach aus der heutigen Datenlage keine sichere Aussage über vermehrtes oder vermindertes Auftreten von Adhäsionen nach nicht readaptiertem Peritoneum gemacht werden.…”

Evaluation of the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy—a controlled prospective multicentre trial: ISSAAC [NCT005725079]

“…First, because of its smooth, monofilament structure this suture material might reduce wound infections in comparison to rough multifilament sutures which promote bacterial adherence and migration by their capillary action [22]. Second, due to its high elasticity and flexibility it might support the mechanics of the abdominal wall and, therefore, might reduce the risk of tear of the suture from the tissue [23]. Finally, as a result of its ultra-long absorption profile and its high tensile strength, it would give the fascia more time to heal and to regain a higher strength which might reduce the development of incisional hernias compared to conventional long-term and short-term absorbable sutures [23].…”