Techniques and materials for closure of the abdominal wall in caesarean section

Abstract

Further trials are justified to investigate whether the apparent increased risk of haematoma or seroma with non-closure of the subcutaneous fat is real. These should use a broader range of short- and long-term outcomes, and ensure that they are adequately powered to detect clinically important differences. Further research comparing blunt and sharp needles is justified, as are trials evaluating suturing materials and suturing techniques for the rectus sheath.

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

“…No data about surgical outcomes, such as incisional hernia, fascial dehiscence, wound complications, or postoperative pain were reported. On the other hand, additional evidence comes from gynecological studies: only in the RCT published by Stafford wound infections were the main outcome [ 81 , 82 ]. Therefore, no recommendations can be given on the use of a different type of needle, but we can recommend the use of blunt tapered needles as an important tool in decreasing the number of incidental glove and visceral perforation.…”

A New Method for Surgical Abdominal Mass Closure After Abdominal Fascial Dehiscence Using Nasogastric Tube and Hemovac Perforator: A Case-Series Study

“…Compared to monofilament, the use of multifilament sutures has been reported to be associated with increased incidence of surgical site infections. There are studies which reported that there is no association between multifilament suture and surgical site infections [22, 23]. It has been assumed that in multifilament sutures a phagocyte dysfunction occurs which bacteria can escape in the interstices between the threads.…”

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

“…No data about surgical outcomes, such as incisional hernia, fascial dehiscence, wound complications, or postoperative pain were reported. On the other hand, additional evidence comes from gynecological studies: only in the RCT published by Stafford wound infections were the main outcome [ 81 , 82 ]. Therefore, no recommendations can be given on the use of a different type of needle, but we can recommend the use of blunt tapered needles as an important tool in decreasing the number of incidental glove and visceral perforation.…”

A New Method for Surgical Abdominal Mass Closure After Abdominal Fascial Dehiscence Using Nasogastric Tube and Hemovac Perforator: A Case-Series Study

“…Compared to monofilament, the use of multifilament sutures has been reported to be associated with increased incidence of surgical site infections. There are studies which reported that there is no association between multifilament suture and surgical site infections [22, 23]. It has been assumed that in multifilament sutures a phagocyte dysfunction occurs which bacteria can escape in the interstices between the threads.…”

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

“…No data about surgical outcomes, such as incisional hernia, fascial dehiscence, wound complications, or postoperative pain were reported. On the other hand, additional evidence comes from gynecological studies: only in the RCT published by Stafford wound infections were the main outcome [ 81 , 82 ]. Therefore, no recommendations can be given on the use of a different type of needle, but we can recommend the use of blunt tapered needles as an important tool in decreasing the number of incidental glove and visceral perforation.…”

A New Method for Surgical Abdominal Mass Closure After Abdominal Fascial Dehiscence Using Nasogastric Tube and Hemovac Perforator: A Case-Series Study

“…Compared to monofilament, the use of multifilament sutures has been reported to be associated with increased incidence of surgical site infections. There are studies which reported that there is no association between multifilament suture and surgical site infections [22, 23]. It has been assumed that in multifilament sutures a phagocyte dysfunction occurs which bacteria can escape in the interstices between the threads.…”