Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions

Grąt, Michał; Morawski, Marcin; Krasnodębski, Maciej; Borkowski, J.; Krawczyk, Piotr; Grąt, Karolina; Stypułkowski, Jan; Maczkowski, Bartosz; Figiel, Wojciech; Lewandowski, Zbigniew; Kobryń, Konrad; Patkowski, Waldemar; Krawczyk, Marek; Wróblewski, Tadeusz; Otto, W.; Paluszkiewicz, Rafał; Zieniewicz, Krzysztof

doi:10.1097/sla.0000000000005128

Cited by 5 publications

(3 citation statements)

References 49 publications

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“…The literature search identified two large meta-analyses 8 , 31 addressing the evidence on suture materials and suture technique for the closure of laparotomies, and two systematic review and meta-analyses 7 , 32 of antimicrobial-coated sutures. Additionally, three RCTs of antimicrobial-coated sutures, 33–35 one 36 of the small-bites technique, and one 37 comparing mass with layered closure in transverse incisions published after these systematic reviews and meta-analyses were identified.…”

Section: Resultsmentioning

confidence: 99%

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Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Deerenberg

Henriksen

Antoniou

et al. 2022

British Journal of Surgery

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Background Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. Methods A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. Results Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. Conclusion These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.

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Section: Resultsmentioning

confidence: 99%

“…Subgroups for closure in non-midline incisions were too small. A recent trial 37 comparing the early results of mass and layered closure of upper abdominal transverse incisions suggested that layered closure should be preferred. However, it represents the initial results of an ongoing RCT with limited clinical value as yet.…”

Section: Resultsmentioning

confidence: 99%

Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Deerenberg

Henriksen

Antoniou

et al. 2022

British Journal of Surgery

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show abstract

“…They found no differences regarding IH formation, but did describe a longer closure time for interrupted layered suture ( 31 ). A recent trial has shown a significant reduction of SSI using layer closure ( 32 ). Long-term results have not yet been published comparing these methods of closure.…”

Section: Closing the Incisionsmentioning

confidence: 99%

Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen

Pedrique¹,

Lersundi²,

Oliveros³

et al. 2023

J. Abdom. Wall Surg.

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Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.

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Update of risk factors for surgical site infection in clean-contaminated wounds after gastroenterological surgery: An analysis of 1,878 participants enrolled in 2 recent randomized control trials for the prevention of surgical site infection

Maemoto¹,

Noda²,

Ichida³

et al. 2023

Surgery

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Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions

Cited by 5 publications

References 49 publications

Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen

Update of risk factors for surgical site infection in clean-contaminated wounds after gastroenterological surgery: An analysis of 1,878 participants enrolled in 2 recent randomized control trials for the prevention of surgical site infection

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