Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis

Abstract

Background There are many options and little guiding evidence when choosing suture types with which to close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence. Methods and methods In February 2017, the Cochrane Central Register of Controlled Trials, Medline, EMBASE and Science Citation Index Expanded were searched for randomised controlled trials investigating the effect of suture choice on these four complications in closing the abdomen. A reference search of identified trials was performed. Prisma guidelines and the Cochrane risk of bias tool were followed in the data extraction and synthesis. Two review authors screened titles and abstracts of trials identified. A random effect model was used for the surgical site infection network based on the deviance information criterion statistics. Results Thirty-one trials were included (11,533 participants). No suture material reached the predetermined 90% probability threshold for determination of ‘best treatment’ for any outcome. Pairwise comparisons largely showed no differences between suture types for all outcomes measured. However, nylon demonstrated a reduction in the occurrence of incisional hernias with respect to two commonly used absorbable sutures: polyglycolic acid (odds ratio, OR 1.91; 95% confidence interval, CI, 1.01–3.63) and polyglyconate (OR 2.18; 95% CI 1.17–4.07). Conclusions No suture type can be considered the ‘best treatment’ for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.

Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

“…The incidence of incisional hernias that can be attributed to a certain suture type has been subject to fierce discussion in the surgical literature and was summed up by a recently published Cochrane review. The authors could not draw an evidence-based conclusion with regard to the most suitable suture materials which prevents all adverse events most effectively [ 13 ]. In our cohort, we currently do not provide any data on incisional hernias but further follow-up will clarify that issue.…”

“…There have been multiple studies on the best modalities of fascial closure after elective abdominal surgery procedures, comparing continuous to interrupted or absorbable to non-absorbable sutures. In the end, no significant differences have been found with regard to burst abdomen or incisional hernia in meta-analyses [ 12 , 13 ]. Generally, the risk of incisional hernia after abdominal surgery ranges from 12 to 25% [ 1 , 14 ] and reaches incidences as high as 83% after burst abdomen [ 15 ].…”

Influence of Suture Materials on Incisional Hernia Rate after Laparoscopic Colorectal Cancer Surgery: A Propensity Score Analysis

“…This guideline recommended the avoidance of fast-absorbable sutures and suggested the use of a slowly-absorbable monofilament sutures. On the other hand, it was reported that nylon sutures reduced the incisional hernia rate compared with both fast-absorbable and slowlyabsorbable sutures [17]. The best suture material for preventing incisional hernia remains unclear.…”

Comparación entre Suturas Convencional Coadyuvada con Ulmoplus® y sin Ulmoplus® en el Cierre de Incisiones de Piel de Conejo ( Oryctolagus cuniculus )

“…J. Morphol., 37(3):1073-1078, 2019 SUMMARY: Considering the advances in research that relate honey therapeutic effects in wound healing process, the present investigation aimed to evaluate and compare qualitatively, through morphological analysis, the local tissue response between conventional suture with Ulmoplus ® and without Ulmoplus ® in the closure of the rabbit skin incision. We used 10 adult rabbits, divided into group S (suture) and group S + U (suture plus Ulmoplus®).…”