Prevention of Incisional Hernias

Israelsson, Leif A.; Millbourn, Daniel

doi:10.1016/j.suc.2013.06.009

Cited by 109 publications

(41 citation statements)

References 59 publications

(102 reference statements)

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“…SL:WL ≥4:1 has been recommended for median celiotomy closure in humans,15, 16, 17 given that incisional herniation has been found more common in wounds closed with SL:WL <4:1 16, 17. A recent trend in human median abdominal closure favors small bites over large bites while observing this minimal SL:WL of 4:1 18, 19.…”

Section: Discussionmentioning

confidence: 99%

“…We arbitrarily chose 2‐mm and 5‐mm bites, representing small and large bite closure, respectively. Advantages of small bite closure include reduced incidence of surgical site infection, better distribution of tension across the celiotomy closure, and reduced incidence of incisional herniation 17, 18, 19. Large SBSI may cause the suture to cut through or compress soft tissues when tension is applied, making the stitch loosen and allowing wound edges to separate 17, 18.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, limitations of our study remain inherent to its ex vivo design. Suture degradation, surgical site infection, prolonged inflammation, suture failure during cyclic and repetitive tension, and other patient‐related factors that contribute to incisional hernia in vivo following ventral midline celiotomy closure2, 3, 13, 16, 17, 19 could not be evaluated in our ex vivo study. We also tested discrete segments of ventral abdominal wall, providing an idea of the dynamic properties of the 3 regions tested and their biomechanical properties but making extrapolations of results to the entire ventral abdominal wall impossible.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical properties of feline ventral abdominal wall and celiotomy closure techniques

et al. 2017

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ObjectiveTo compare biomechanical properties and mechanism of failure of 3 regions of ventral abdominal wall in cats by using 2 suture materials, 2 suture bite‐to‐stitch intervals (SBSI), and full‐thickness versus fascia‐only closure.Study DesignRandomized, cadaveric, ex vivo mechanical testing.Sample Population16 adult cat cadavers, 3 samples per cat.MethodsThree regions of ventral abdominal wall were mechanically tested (N = 48 samples). Preumbilical, umbilical (U), and postumbilical (POU) regions were harvested by using a template. The thickness of the linea alba was recorded. Six samples without celiotomy served as controls. Twenty‐eight samples were randomized to SBSI (2 × 2 or 5 × 5 mm) and suture material (3‐0 polyglactin 910 or 3‐0 polydioxanone) for simple continuous celiotomy closure. Fourteen samples were randomized to full‐thickness or fascia‐only closure. Samples were tested by linear distraction; tensile strength and mechanism of failure were recorded. Effects of body weight, thickness of linea alba, anatomic region, SBSI, type of closure, and suture material were evaluated by mixed model linear analysis. Load to failure was compared between males and females, full‐thickness and fascia‐only closure by independent t test, with P < .05 considered statistically significant.ResultsThe POU region achieved lower loads to failure. Load to failure was greater in males compared with females. No difference was detected between full‐thickness and fascia‐only closure. Failure most commonly occurred by tearing of suture through tissues. Tissue failure with suture line loosening occurred mainly in the 5 × 5‐mm SBSI group.ConclusionThe POU region is biomechanically weak and may therefore be predisposed to incisional herniation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical properties of feline ventral abdominal wall and celiotomy closure techniques

et al. 2017

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“…Although, the most important factor determining the failure of the fascia is not the suture type, since many different factors are influencing (individual’s own biological factors, presence of infection, technical skill of the surgeon, etc…), both clinical and experimental studies [18,19] have examined the influence of different suture types on the closure of a midline laparotomy independently of other important factors such running versus interrupted suture, distance between stitches and the width of the tissue margin included in the suture [20]. …”

Section: Discussionmentioning

confidence: 99%

New suture materials for midline laparotomy closure: an experimental study

et al. 2014

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BackgroundMidline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure.MethodsThree 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies.ResultsNo signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p < 0.001). This response was similar for the non-reabsorbable sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p < 0.01). At this early time point, the tensile strength of PUe was similar to that of control intact tissue (p > 0.05).ConclusionThree weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture.

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“…In summary, it must be concluded that according to current evidence, the meticulousness of abdominal wall closure based on Israelsson’s recommendations [11, 32] appears to be the most appropriate approach irrespective of the surgical indications.…”

Section: Discussionmentioning

confidence: 99%

The incidence of incisional hernia after aortic aneurysm is not higher than after benign colorectal interventions

et al. 2018

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BackgroundAbdominal aortic aneurysms (AAA) have most probably an inflammatory origin, whereby the elastica is the layer actually involved. In the past, collagen weackness was supposed to be the shared cause of both, AAA and incisional hernias. Since the development of new techniques of closure of the abdominal wall over the last decade, collagen deficency seems to play only a secondary etiologic role.ObjectivesThe aim of the study was to investigate whether the incidence of incisional hernia following laparotomy due to AAA differs from that of colorectal interventions.Material and methodsThis was a retrospective control matched cohort study. After screening of 403 patients with colorectal interventions and 96 patients with AAA, 27 and 72 patients, respectively were included. The match criteria for inclusion of patients with colorectal interventions were: age, benign underlying disease and median xiphopubic laparotomy. The primary endpoint was the incidence of an incisional hernia. The secondary endpoints were the risk profile, length of stay in the intensive care unit and postoperative complications. Data analysis was carried in the consecutive collective from 2006 to 2008.ResultsIn the group with AAA the mean follow-up was 34.5±18.1 months and in the group with colorectal interventions 35.7±21.4 months. The incidence of incisional hernias showed no significant differences between the two groups. In the AAA group 10 patients (13.8%) developed an incisional hernia in contrast to 7 patients in the colorectal intervention group (25.9%).ConclusionsIn our collective patients with AAA did not show an increased incidence of incisional hernia in comparison to patients with colorectal interventions with comparable size of the laparotomy access and age. The quality of closure of the abdominal wall seems to be an important factor for the prevention of incisional hernia.

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Prevention of Incisional Hernias

Cited by 109 publications

References 59 publications

Biomechanical properties of feline ventral abdominal wall and celiotomy closure techniques

Biomechanical properties of feline ventral abdominal wall and celiotomy closure techniques

New suture materials for midline laparotomy closure: an experimental study

The incidence of incisional hernia after aortic aneurysm is not higher than after benign colorectal interventions

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