Introduction of Small Stitch Small Bite technique: a retrospective long-term follow-up

Abstract

Purpose Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to explore the impact of a structured introduction of guidelines for abdominal wall closure on the rates of incisional hernia and wound dehiscence. Methods All procedures performed via a midline incision in 2010–2011 and 2016–2017 at Capio St Göran’s Hospital were identified and assessed for complications and risk factors. Results Six hundred two procedures were registered in 2010–2011, and 518 in 2016–2017. Four years after the implementation of new guidelines, 93% of procedures were performed using the standardized technique. There was no significant difference in the incidence of incisional hernia or wound dehiscence between the groups. In multivariate Cox proportional hazard analysis, BMI > 25, wound dehiscence, and postoperative wound infection were found to be independent risk factors for incisional hernia (all p < 0.05). In multivariate logistic regression analysis, male gender and chronic obstructive pulmonary disease were risk factors for wound dehiscence (both p < 0.05). Conclusions The present study failed to show a significant improvement in rates of incisional hernia and wound dehiscence after the introduction of Small Stitch Small Bites. When introducing a new standardized technique for closing the abdomen, education and structural implementation of guidelines may have an impact in the long run. The risk factors identified should be taken into consideration when closing a midline incision to identify patients with high risk.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure

“…Suture pull-through is the primary culprit in incisional hernia (IH) development which occurs in 24% of sutured laparotomy closures ( 8 ). Among those who treat the abdominal wall, solutions are many: the “small-bites” suturing technique ( 9 , 10 ), the use of planar meshes ( 11 ), anterior and posterior component release, preoperative injection of botulinum toxin into the lateral abdominal musculature ( 12 ), and minimally-invasive techniques that avoid large abdominal wall incisions entirely. Nevertheless, these alternative and complementary techniques have not yet eliminated IH formation and thus reflect the continuing need for innovation in abdominal wall closure.…”

A Comparison of a Small-Stitch Closure With a Standard Closure in Midline Laparotomy Incisions: A Prospective Comparative Study

“…In the short stitch suture technique, only the aponeurotic layer is brought into apposition, and the tension on one stitch is reduced by the addition of extra sutures. Thus, there is less slackening of sutures and reduced necrotic tissue [15]. Hence, the chances of SSI, wound dehiscence, and incisional hernia are lower [8,16].…”

Incisional Hernia Depends on More Than Just Mesh Placement

“…Finally, it is interesting to note that other studies concerning the closure of the abdominal wall, where the efficacy of meshes in the treatment or prevention of IH is not evaluated, reveal similar curves. Specifically, a long-term analysis of the results of the application of the closure technique recommended in clinical guidelines (i.e., small bites) after both elective and emergency midline laparotomy [ 17 , 18 ].…”