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Santilli O, Santilli H, Nardelli N. Videoendoscopic assisted Rives-Stoppa technique. "Treatment for epigastric and umbilical hernias with diastasis recti". Hernia 2024:10.1007/s10029-024-03151-4. [PMID: 39240471 DOI: 10.1007/s10029-024-03151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE There are many surgical techniques for ventral hernias and diastasis recti, both conventional or video-endoscopic, with or without mesh placement, detailed in the literature. Using some details of the techniques proposed by Wolfgang Reinpold (Mini- or Less Open Sublay Operation, MILOS) and Federico Fiori (Totally Endoscopic Sublay Anterior Repair, TESAR) we found modifications that allowed repairing and reinforcement of the posterior fascia with a retro-muscular mesh and achieve primary fascial closure by minimally umbilical access and searching for the best anatomical, functional, and aesthetic results. METHOD Describe the surgical technique step by step and analyze 629 surgical treatments. The cohort comprises the period January 2018 to January 2023. Our Database registered 318 men and 311 women who underwent video endoscopicassisted Rives-Stoppa techniques to treat umbilical and epigastric hernias with diastasis RESULTS: All patients were treated on an outpatient basis and discharged home on the same day. The most frequent complications were seromas with conservative management. Other complications recorded were omphalitis in 6 patients, and three patients presented hematomas, one of whom performed surgical evacuation. There were ten patients with recurrences. CONCLUSION These hybrid approaches provide the advantages of mini-invasive techniques with a lower rate of complications and a high standard of quality of life, providing anatomical, functional, and aesthetic benefits.
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Affiliation(s)
- Osvaldo Santilli
- Centro de Patología Herniaria Argentina, Cerviño, 4449 (Zip Code 1425), Buenos Aires, Argentina.
| | - Hernán Santilli
- Centro de Patología Herniaria Argentina, Cerviño, 4449 (Zip Code 1425), Buenos Aires, Argentina
| | - Nicolás Nardelli
- Centro de Patología Herniaria Argentina, Cerviño, 4449 (Zip Code 1425), Buenos Aires, Argentina
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2
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Sachsamanis G, Delgado JP, Oikonomou K, Schierling W, Pfister K, Zuelke C, Betz T. Wound healing and hernia after abdominal aortic aneurysm repair: Onlay self-gripping polyester mesh reinforcement compared with small bite sutured closure. Clin Hemorheol Microcirc 2024; 87:315-322. [PMID: 38277284 DOI: 10.3233/ch-232008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Prophylactic mesh implantation following open surgical repair of abdominal aortic aneurysm is a debatable subject. OBJECTIVE To assess the efficacy of a self-gripping polyester mesh used in on-lay technique to prevent incisional hernia after open abdominal aortic aneurysm repair. METHODS We retrospectively reviewed the records of 495 patients who underwent aortic surgery between May 2017 and May 2021. Patients included in the study underwent open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with closure of the abdominal wall with either small bite suture technique or prophylactic mesh reinforcement. Primary endpoint of the study was the occurrence of incisional hernia during a two-year follow-up period. Secondary endpoints were mesh-related complications. RESULTS Mesh implantation with the on-lay technique was successful in all cases. No patient in the mesh group developed an incisional hernia during the 24-month follow-up period. Two patients in the non-mesh group developed a symptomatic incisional hernia during the follow-up period at 6 months. Three cases of post-operative access site complications were observed in the mesh group. CONCLUSIONS Application of a self-gripping polyester mesh using the on-lay technique demonstrates acceptable early-durability after open surgical repair of abdominal aortic aneurysms. However, it appears to be associated with a number of post-operative access site complications.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julio Perez Delgado
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Carl Zuelke
- Department of Visceral Surgery, Rotthalmünster Hospital, Rotthalmünster, Germany
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Ghai GS, S H. A Comparison of a Small-Stitch Closure With a Standard Closure in Midline Laparotomy Incisions: A Prospective Comparative Study. Cureus 2023; 15:e50035. [PMID: 38186468 PMCID: PMC10768337 DOI: 10.7759/cureus.50035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Midline incision provides a rapid and thorough approach to the abdominal cavity and, therefore, is widely employed in both emergency and elective procedures. However, midline laparotomy is associated with many post-operative complications like wound dehiscence, incisional hernia, fistula formation, and surgical site infection (SSI). The purpose of the study is to compare the complications that occurred post-operatively in association with the long and small bite suture techniques for midline laparotomy incisions. Methodology A prospective comparative study was carried out among 90 cases of midline laparotomies for 18 months (January 2021 to June 2022). The participants were categorized into two groups: (1) Group A, which included 45 patients, underwent small-suture abdominal fascia closure, and (2) Group B, which consisted of the remaining 45 patients, underwent large-suture abdominal midline wound closure. Patients were followed up in the hospital till the day of discharge and in the outpatient department (visit 1, within one month of surgery) for pain, wound dehiscence, and surgical site infection. Patients were called for visit 2 (six months post-surgery) and incisional hernia rates were assessed. Results On the numerical pain rating scale, the mean score was higher in Group B, that is, 4.1 than in Group A, which was 3.5. Wound dehiscence and incisional hernia rates were higher among Group B cases. The majority of SSIs were noted in Group B with statistically significant results. Conclusion Despite the lack of randomization, the results demonstrated in this study support the use of small bite sutures in comparison to long bite sutures for laparotomy closure.
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Affiliation(s)
- Gunjot Singh Ghai
- Department of General Surgery, Jagadguru Sri Shivarathreeshwara (JSS) Medical College and Hospital, Mysuru, IND
| | - Harish S
- Department of General Surgery, Jagadguru Sri Shivarathreeshwara (JSS) Medical College and Hospital, Mysuru, IND
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van Steensel S, Deerenberg EB, Poelman MM. Abdominal wall closure. Br J Surg 2023; 110:1597-1600. [PMID: 37713648 DOI: 10.1093/bjs/znad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Affiliation(s)
| | - Eva B Deerenberg
- Department of General Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Marijn M Poelman
- Department of General Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
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5
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Christoffersen MW, Henriksen NA. Treatment of primary ventral and incisional hernias. Br J Surg 2023; 110:1419-1421. [PMID: 37178163 DOI: 10.1093/bjs/znad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Affiliation(s)
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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6
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González-Abós C, Pineda C, Arrocha C, Farguell J, Gil I, Ausania F. Incisional Hernia Following Open Pancreaticoduodenectomy: Incidence and Risk Factors at a Tertiary Care Centre. Curr Oncol 2023; 30:7089-7098. [PMID: 37622995 PMCID: PMC10453869 DOI: 10.3390/curroncol30080514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Incisional hernia (IH) is one of the most common complications following open abdominal surgery. There is scarce evidence on its real incidence following pancreatic surgery. The purpose of this study is to evaluate the incidence and the risk factors associated with IH development in patients undergoing pancreaticoduodenectomy (PD). (2) Methods: We retrospectively reviewed all patients undergoing PD between 2014 and 2020 at our centre. Data were extracted from a prospectively held database, including perioperative and long-term factors. We performed univariate and multivariate analysis to detect those factors potentially associated with IH development. (3) Results: The incidence of IH was 8.8% (19/213 patients). Median age was 67 (33-85) years. BMI was 24.9 (14-41) and 184 patients (86.4%) underwent PD for malignant disease. Median follow-up was 23 (6-111) months. Median time to IH development was 31 (13-89) months. Six (31.5%) patients required surgical repair. Following univariate and multivariate analysis, preoperative hypoalbuminemia (OR 3.4, 95% CI 1.24-9.16, p = 0.01) and BMI ≥ 30 kg/m2 (OR 2.6, 95% CI 1.06-8.14, p = 0.049) were the only factors independently associated with the development of IH. (4) Conclusions: The incidence of IH following PD was 8.8% in a tertiary care center. Preoperative hypoalbuminemia and obesity are independently associated with IH occurrence following PD.
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Affiliation(s)
- Carolina González-Abós
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
- Gene Therapy and Cancer, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Catalina Pineda
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Carlos Arrocha
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Jordi Farguell
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Ignacio Gil
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Fabio Ausania
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
- Gene Therapy and Cancer, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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7
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. National survey of colorectal surgery units on abdominal wall closure. Cir Esp 2023; 101:258-264. [PMID: 36108954 DOI: 10.1016/j.cireng.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.
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Affiliation(s)
- Salvador Pous-Serrano
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Providencia García-Pastor
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Bueno-Lledó
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Cuevas N, Beeson ST, Faulkner JD, Edgerton C, Hope WW. Teaching Small Bite Fascial Closure Technique: Improved Accuracy and Consistency Through Simulation. Am Surg 2023:31348231160852. [PMID: 36935586 DOI: 10.1177/00031348231160852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Despite evidence that small bite closure is beneficial, it is not well documented how accurately and consistently surgeons employ this technique. We created a felt model to simulate fascial closure and educate residents regarding small bites. This study aims to gauge accuracy and consistency of bite size in fascial closure and assess if utilizing a templated model could improve technique. Two 10 cm incisions were made in different pieces of felt. Residents were instructed to suture the incisions to simulate fascial closure by running the incisions closed with 1 cm and 5 mm bites respectively. The process was repeated with templated pieces of felt marking 1 and 0.5 cm to guide bite size. Residents were timed for each closure. The travel and distance from the midline for each bite was measured and analysis performed. 14 residents participated. Paired T-test compared means and standard deviations of bite size. Taking 5 mm bites took more time. Standard deviation of travel and right sided distance from midline were significantly smaller when a template was utilized. Standard deviation of travel as well as right sided distance was also improved when instructed to take 5 mm bites. This study demonstrates that a small bite technique results more closure and that when residents are instructed to take smaller bites. The adage, "aim small, miss small," holds true in fascial closure and may be one reason why small bites improve hernia rates. This study also suggests that the use of a template improves accuracy and consistency of closure regardless of bite size intention.
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Affiliation(s)
| | - Seth T Beeson
- Department of Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | | | - Colston Edgerton
- Department of Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | - William W Hope
- 24520New Hanover Regional Medical Center, Wilmington, NC, USA
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9
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ABDELSHAHID MA, ELBALSHY MA, ABU BAKRE F, ELMALLAH AS. "Cross-over" versus mass closure techniques for elective midline laparotomies. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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10
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Durbin B, Spencer A, Briese A, Edgerton C, Hope WW. If Evidence is in Favor of Incisional Hernia Prevention With Mesh, why is it not Implemented? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11000. [PMID: 38312399 PMCID: PMC10831655 DOI: 10.3389/jaws.2023.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2024]
Affiliation(s)
| | | | | | | | - William W. Hope
- Department of Surgery, Novant/New Hanover Medical Center, Wilmington, NC, United States
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11
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Liang C, Zhang R, Xing X, Chen J, Yang H. Predictive value of platelet-related hematological markers in indicating the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM). Surg Endosc 2022; 37:3471-3477. [PMID: 36575222 DOI: 10.1007/s00464-022-09845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The predictive value of hematological markers in the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM) remains to be investigated. We aim to evaluate the role of platelet-related parameters after laparoscopic IPOM in patients with incisional hernias. METHODS The data of 95 patients who underwent laparoscopic IPOM for appendicectomy-related incisional hernias were retrospectively analyzed. The complete blood count analyses were measured preoperatively, and the outcomes were obtained from hospital records and follow-up calls to patients. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) values were calculated. The patients were grouped based on the recurrence and the postoperative complications after surgery. RESULTS Using cutoff values acquired by the Youden Index, we found platelet levels < 212.0 × 1000/μl, NLR > 2.33, LMR < 3.17, and PLM < 365.5 were revealed to be statistically significant in the recurrence of hernias based on univariant or multivariant analysis (p = < 0.05). We further divided the patients into two groups based on the cutoff value of PLM and found that a PLM value < 365.5 was significantly associated with the recurrence of incisional hernia (p = 0.018), the occurrence of postoperative seroma (p = 0.044), and there is a tendency that patients with PLM < 365.5 may suffer from other postoperative complications such as cardiopathy, respiratory infection, and hypoproteinemia (p = 0.089). CONCLUSION The preoperative hematological values, especially PLM, may indicate the outcomes in incisional hernias after laparoscopic IPOM.
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Affiliation(s)
- Chen Liang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Rongjie Zhang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xiaowei Xing
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.,Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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12
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Theodorou A, Banysch M, Gök H, Deerenberg EB, Kalff JC, von Websky MW. Don't fear the (small) bite: A narrative review of the rationale and misconceptions surrounding closure of abdominal wall incisions. Front Surg 2022; 9:1002558. [PMID: 36504582 PMCID: PMC9727106 DOI: 10.3389/fsurg.2022.1002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The most common complications related to the closure of abdominal wall incisions are surgical site infections, wound dehiscence and the development of an incisional hernia. Several factors relating to the surgical technique and the materials used have been identified and analysed over the years, as mirrored in the current recommendations of the European Hernia Society, but some misconceptions still remain that hinder wide implementation. Method A literature search was performed in the PubMed and GoogleScholar databases on 15 July 2021 and additionally on 30 March 2022 to include recent updates. The goal was to describe the scientific background behind the optimal strategies for reducing incisional hernia risk after closure of abdominal wall incisions in a narrative style review. Results An aponeurosis alone, small bites/small steps continuous suture technique should be used, using a slowly resorbable USP 2/0 or alternatively USP 0 suture loaded in a small ½ circle needle. The fascial edges should be properly visualised and tension should be moderate. Conclusion Despite the reproducibility, low risk and effectiveness in reducing wound complications following abdominal wall incisions, utilisation of the recommendation of the guidelines of the European Hernia Society remain relatively limited. More work is needed to clear misconceptions and disseminate the established knowledge and technique especially to younger surgeons.
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Affiliation(s)
- Alexis Theodorou
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany,Correspondence: Alexis Theodorou
| | - Mark Banysch
- Department of Surgery, St. Bernhard Hospital Kamp-Lintfort, Kamp-Lintfort, Germany
| | - Hakan Gök
- Hernia Istanbul, Hernia Istanbul®, Hernia Surgery Center, Istanbul, Turkey
| | - Eva B. Deerenberg
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Joerg C. Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin W. von Websky
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
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13
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Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, Fortelny RH, Gök H, Harris HW, Hope W, Horne CM, Jensen TK, Köckerling F, Kretschmer A, López-Cano M, Malcher F, Shao JM, Slieker JC, de Smet GHJ, Stabilini C, Torkington J, Muysoms FE. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 2022; 109:1239-1250. [PMID: 36026550 PMCID: PMC10364727 DOI: 10.1093/bjs/znac302] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
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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Affiliation(s)
- Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Nadia A Henriksen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - George A Antoniou
- Department of Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros A Antoniou
- Mediterranean Hospital of Cyprus, Limassol, Cyprus.,Medical School, European University Cyprus, Nicosia, Cyprus
| | - Wichor M Bramer
- Medical Library, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - John P Fischer
- Department of Plastic Surgery, University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Rene H Fortelny
- Certified Hernia Center, Wilhelminenspital, Veinna, Austria.,Paracelsus Medical, University Salzburg, Salzburg, Austria
| | - Hakan Gök
- Hernia Istanbul®, Hernia Surgery Centre, Istanbul, Turkey
| | - Hobart W Harris
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - William Hope
- Department of Surgery, Novant/New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - Charlotte M Horne
- Department of Surgery, Penn State Health Department, Hershey, Pennsylvania, USA
| | - Thomas K Jensen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt-Hospital, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Alexander Kretschmer
- Klinikum der Ludwig-Maximillians-Universität München, Munchen, Germany.,Janssen Oncology, Los Angeles, CA, USA
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Unviversitat Autònoma de Barcelona, Barcelona, Spain
| | - Flavio Malcher
- Department of Surgery, NYU Langone Health/NYU Grossman School of Medicine, New York, New York, USA
| | - Jenny M Shao
- Division of Gastrointestinal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gijs H J de Smet
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Cesare Stabilini
- Department of Surgery, Policlinico San Martino IRCCS and Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Jared Torkington
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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14
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Wehrle CJ, Shukla P, Miller BT, Blake KE, Prabhu AS, Petro CC, Krpata DM, Beffa LR, Tu C, Rosen MJ. Incisional hernia rates following midline laparotomy in the obese patient: a retrospective review. Hernia 2022; 27:557-563. [DOI: 10.1007/s10029-022-02688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
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Shaw RD, Goldwag JL, Wilson LR, Ivatury SJ, Tsapakos MJ, Pauli EM, Wilson MZ. Retrorectus mesh reinforcement of ileostomy site fascial closure: stoma closure and reinforcement (SCAR) trial phase I/II results. Hernia 2022; 26:1645-1652. [PMID: 36167868 DOI: 10.1007/s10029-022-02681-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Loop ileostomy (LI) is commonly employed during colorectal surgeries to reduce the consequences of anastomotic leak. Unfortunately, LI is associated with a 10-30% incisional hernia (IH) rate after closure. We hypothesized that prophylactic mesh reinforcement during LI takedown would safely prevent subsequent IH formation. METHODS This single-center, phase I/II prospective study evaluated adult patients undergoing LI closure after left-sided colorectal cancer procedures. After LI closure, the posterior rectus sheath was mobilized and reapproximated with absorbable suture. A reduced-weight, macroporous, polypropylene mesh (Softmesh, BD) was placed in the retrorectus position to allow 3 cm of overlap and secured with fibrin sealant. The anterior fascia was closed with slowly absorbable suture. CT images obtained for cancer surveillance were reviewed by a radiologist blinded to the study intervention to evaluate for evidence of hernia or surgical site occurrence (SSO). RESULTS Twenty patients were included with mean defect and mesh sizes of 11.2 cm2 and 64.2 cm2, respectively. Mean operative time for LI takedown and mesh augmented closure was 84 min with mesh implantation time being 16.4 min. Two patients were readmitted within 30 days for ileus, no patient required procedural intervention. Over a mean follow-up period of 20 ± 7 months, no SSO or hernias were observed clinically or on CT imaging. CONCLUSION In our small series, retromuscular mesh reinforcement of LI closure appears feasible, safe and effective. This mesh reinforcement approach should be further investigated to evaluate its long-term effectiveness.
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Affiliation(s)
- R D Shaw
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - J L Goldwag
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - L R Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Hanover, NH, USA
| | - S J Ivatury
- Dell Medical School, UT Health, Austin, TX, USA
| | - M J Tsapakos
- Geisel School of Medicine, Hanover, NH, USA.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - E M Pauli
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - M Z Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA. .,Geisel School of Medicine, Hanover, NH, USA.
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. Encuesta nacional a unidades de cirugía colorrectal sobre el cierre de pared abdominal. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Gómez Sánchez J, Forneiro Pérez R, Zurita Saavedra M, de Castro Monedero P, González Puga C, Garde Lecumberri C, Mirón Pozo B. Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question. Int J Colorectal Dis 2022; 37:373-379. [PMID: 34854980 DOI: 10.1007/s00384-021-04074-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. METHODS This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1 g and erythromycin 500 mg the day before surgery. RESULTS The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05). CONCLUSION Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.
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Affiliation(s)
- Javier Gómez Sánchez
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Rocio Forneiro Pérez
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Marisol Zurita Saavedra
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Paola de Castro Monedero
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Cristina González Puga
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Carlos Garde Lecumberri
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
| | - Benito Mirón Pozo
- Department of Colorectal Surgery, Hospital Universitario Clínico San Cecilio, Avd. de la Investigación s/n, 18016, Granada, Spain
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18
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Pereira Rodríguez JA, López Cano M. Evidence-based midline laparotomy closure and evidence of its use. Cir Esp 2021; 100:1-2. [PMID: 34863661 DOI: 10.1016/j.cireng.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- José Antonio Pereira Rodríguez
- Departamento de Cirugía General y Digestiva, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Secretario de la Sección de Pared Abdominal de la Asociación Española de Cirujanos; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Manuel López Cano
- Departamento de Cirugía, Universitat Autónoma de Barcelona, Barcelona, Spain; Unidad de Cirugía de la Pared Abdominal, Hospital Vall d'Hebron, Barcelona, Spain; Coordinador de la Sección de Pared Abdominal de la Asociación Española de Cirujanos
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Beeson S, Faulkner J, Acquista E, Hope W. Decreasing Incisional Hernia by Teaching 4:1 Suture to Wound Length Ratio Early in Surgical Education. JOURNAL OF SURGICAL EDUCATION 2021; 78:e169-e173. [PMID: 34642098 DOI: 10.1016/j.jsurg.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/20/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Incisional hernia formation has become a major burden for our healthcare system. One factor that has been shown to reduce incisional hernia rates that can be impacted on by the surgeon is the ability to achieve a 4:1 suture to wound length ratio. The purpose of this study is to evaluate whether a focused educational program for surgical residents can help improve laparotomy closures and be successful in achieving 4:1 suture to wound length ratios. DESIGN Following Institutional Review Board approval, consecutive abdominal wall closures were reviewed from December 2013 to July 2016. S:W length ratios were calculated in all cases and after 100 cases a formal audit of success and risk factors for not achieving a 4:1 ratio was performed followed by a formal resident education on laparotomy closure. The ability to achieve a 4:1 ratio for the first 100 cases following resident education was then compared to the 100 patients preceding the education with a p-value of <0.05 considered significant. RESULTS Two hundred patients underwent midline laparotomy with S:W length ratio calculated. In the first 100 patients, 76% of patients received a 4:1 S:W closure. Following resident education, this improved to 90% in the second 100 patients (p = 0.0083). Among patients where 2 residents performed the abdominal closure, 50% got an adequate 4:1 closure. This improved to 92% for the second 100 patients (p = 0.016). CONCLUSION A 4:1 S:W length ratio is a simple technique that has been proven to decrease incisional hernia. It requires no additional cost and can easily be implemented into practice. The act of formal resident education and measuring suture tails to calculate a S:W ratio on each case holds surgeons accountable and improves success rate of achieving a 4:1 ratio.
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Affiliation(s)
- Seth Beeson
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Justin Faulkner
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Elizabeth Acquista
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - William Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina.
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20
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High rate of incisional hernia observed after mass closure of burst abdomen. Hernia 2021; 26:1267-1274. [PMID: 34674087 DOI: 10.1007/s10029-021-02523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. METHODS The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3 cm and small steps of 5 mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. RESULTS Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17 months (min 4, max 67 months). CONCLUSION Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients.
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21
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Terada Y, Miyake T, Ueki T, Shimizu T, Kojima M, Takebayashi K, Maehira H, Kaida S, Yamaguchi T, Iida H, Tani M. Incidence of surgical site infections with triclosan-coated monofilament versus multifilament sutures in elective colorectal surgery. Surg Today 2021; 52:652-659. [PMID: 34664093 DOI: 10.1007/s00595-021-02383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Surgical site infections (SSIs) are the most frequent complication of abdominal surgery. Using triclosan-coated sutures for abdominal wall closure reportedly reduces the incidence of SSIs. However, the SSI incidence has not been compared between the use of triclosan-coated multifilament and triclosan-coated monofilament sutures. We, therefore, compared the incidence of incisional SSIs between the use of triclosan-coated polyglactin 910 sutures (Vicryl Plus) and triclosan-coated polydioxanone sutures (PDS Plus). METHODS This observational cohort study was conducted on 318 consecutive patients who underwent elective colorectal cancer surgery at the Shiga University of Medical Science Hospital from January 2015 to December 2018. Based on the suture type for abdominal wall closure, 151 patients were enrolled in the PDS Plus group, and 167 were enrolled in the Vicryl Plus group. RESULTS The two suture groups were not significantly different in terms of risk factors for SSIs. Other postoperative complications also did not differ markedly between the two groups. In the multivariate logistic regression analysis, the presence of stoma was the only independent risk factor for incisional SSIs. CONCLUSION The incidence of incisional SSIs was unaffected by the type of triclosan-coated sutures. The presence of stoma was an independent risk factor for incisional SSIs.
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Affiliation(s)
- Yoshitaka Terada
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan.
| | - Tomoyuki Ueki
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Division of Medical Security and Patient Safety, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Masatsugu Kojima
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Hiroya Iida
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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22
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Zolin SJ, Rosen MJ. Failure of Abdominal Wall Closure: Prevention and Management. Surg Clin North Am 2021; 101:875-888. [PMID: 34537149 DOI: 10.1016/j.suc.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This article reviews evidence-based techniques for abdominal closure and management strategies when abdominal wall closures fail. In particular, optimal primary fascial closure techniques, the role of prophylactic mesh, considerations for combined hernia repair, closure techniques when the fascia cannot be closed primarily, and management approaches for fascial dehiscence are reviewed.
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Affiliation(s)
- Samuel J Zolin
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA.
| | - Michael J Rosen
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA
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Hermann M, Gustafsson O, Sundqvist P, Sandblom G. Rate of incisional hernia after minimally invasive and open surgery for renal cell carcinoma: a nationwide population-based study. Scand J Urol 2021; 55:372-376. [PMID: 34286660 DOI: 10.1080/21681805.2021.1953579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. MATERIALS AND METHODS From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. RESULTS In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0-6.4%) after open surgery and 2.4% (95% CI = 1.0-3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. CONCLUSIONS Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.
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Affiliation(s)
- Maria Hermann
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Department of Surgery, Södersjukhuset, Stockholm, Sweden
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What Is the Proper Technique for Primary Laparotomy Closure? Adv Surg 2021; 55:197-214. [PMID: 34389092 DOI: 10.1016/j.yasu.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sofii I, Kalembu RS, Fauzi AR, Makrufardi F, Makhmudi A. TGF -β expression on different suturing technique for abdominal skin wound closure in rats. Ann Med Surg (Lond) 2021; 67:102521. [PMID: 34194734 PMCID: PMC8226395 DOI: 10.1016/j.amsu.2021.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background The method of closing the abdominal wall, as well as, the choice of material for stitching are important aspects of efficient incision closure. Generally, transforming growth factor-beta (TGF-β) is involved in the wound healing process. Suturing procedures also play a part in the wound dehiscence occurrence. This study aimed to compare TGF-β expressions in rats after using the large stitch vs. small stitch technique for abdominal skin wound closure. Methods A total of twenty Wistar rats (Rattus norvegicus) were used in this experiment. Small tissue bites of 5 mm were obtained by the small stitch group and the large stitch group received large bites of 10 mm. Abdominal skin incisions were closed by running sutures. On days 4 and 7, the animals were euthanized. For TGF-β expressions, histological parts of the tissue-embedded sutures were analyzed. With significance set at p < 0.05, two-way ANOVA showed that on days 4 and 7, the TGF-β expressions of the rats in the small stitch group were nearly identical to those in the large stitch groups. Results After including twenty rats in this study, results showed the TGF-β expressions on days 4 and 7 in rats in the small stitch group were equivalent to those in the large stitch group. (p = 0.45). Conclusions Between the small and the large stitch groups, the TGF-β expressions are similar, suggesting that the suturing methods do not have any significantly different beneficial impact on the frequency of wound dehiscence. TGF-β promoting collagen and fibronectin formation in various fibroblast cell lines. TGF-β expressions are similar between the small and the large stitch groups. Different suturing methods do not have a beneficial impact on the frequency of wound dehiscence.
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Affiliation(s)
- Imam Sofii
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Ratna Sari Kalembu
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Aditya Rifqi Fauzi
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Firdian Makrufardi
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Akhmad Makhmudi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Use of a bioabsorbable mesh in midline laparotomy closure to prevent incisional hernia: randomized controlled trial. Hernia 2021; 26:1231-1239. [PMID: 34057625 DOI: 10.1007/s10029-021-02435-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/24/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of closure of a midline laparotomy for IH prevention. MATERIALS AND METHODS A multicenter, randomized clinical trial including patients undergoing abdominal surgical procedures through a midline laparotomy incision was designed. In the group of mesh (n = 167) the incision was closed using a continuous polydioxanone suture (PDS) plus a bioabsorbable mesh. In the control group (n = 165) a continuous PDS single layer suture was only used. Patients were randomly assigned (1:1) to the two groups. The primary outcome was the incidence of IH at 6, 12 and 24 months. Assessment of IH was done using a CT scan. RESULTS At 6 months, the rates of IH were 15.2% and 24.8% in the experimental and control groups, respectively (relative risk [RR] 0.66, 95% confidence interval [CI] 0.38-0.98, P = 0.042). At 12 months, the rate of IH continued to be significantly lower in the experimental group (21.4% vs. 33.1%, P = 0.033), but at 24 months, there were no significant differences between the study groups with a follow-up rate of only 37.5%. The number needed to treat (NNT) was 11 and 9 at 6 and 12 months, respectively. CONCLUSION The bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a "palliative" transient effect for preventing IH in the long-term.
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Weyhe D, Salzmann D, Gloy K. [Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. Chirurg 2021; 92:621-629. [PMID: 33913011 DOI: 10.1007/s00104-021-01415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.
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Affiliation(s)
- Dirk Weyhe
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Daniela Salzmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Kilian Gloy
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
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Pereira Rodríguez JA, López Cano M. Evidence-based midline laparotomy closure and evidence of its use. Cir Esp 2021; 100:S0009-739X(21)00126-3. [PMID: 33875190 DOI: 10.1016/j.ciresp.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022]
Affiliation(s)
- José Antonio Pereira Rodríguez
- Departamento de Cirugía General y Digestiva, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, España; Secretario de la Sección de Pared Abdominal de la Asociación Española de Cirujanos; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España.
| | - Manuel López Cano
- Departamento de Cirugía, Universitat Autònoma de Barcelona, Barcelona, España; Unidad de Cirugía de la Pared Abdominal, Hospital Vall d'Hebron, Barcelona, España; Coordinador de la Sección de Pared Abdominal de la Asociación Española de Cirujanos
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29
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Counting stitches does not save time. Surgery 2021; 169:1561. [PMID: 33773823 DOI: 10.1016/j.surg.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
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Calcerrada Alises E, San Miguel Méndez C, Cruz Cidoncha A, Minaya Bravo A, Pérez-Flecha González M, Garcia-Urena MA. The small bites technique for closure of abdominal midline incisions - a video vignette. Colorectal Dis 2021; 23:765. [PMID: 33319425 DOI: 10.1111/codi.15492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Carlos San Miguel Méndez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Arturo Cruz Cidoncha
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ana Minaya Bravo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Marina Pérez-Flecha González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Angel Garcia-Urena
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
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Güsgen C, Willms A, Schaaf S, Prior M, Weber C, Schwab R. Lack of Standardized Advice on Physical Strain Following Abdominal Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:737-744. [PMID: 33439823 DOI: 10.3238/arztebl.2020.0737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/26/2019] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Germany as elsewhere, standardized recommendations are lacking on the avoidance of physical exertion to protect the abdom - inal wall in patients who have recently undergone abdominal surgery. It is unclear how much stress the abdominal wall can withstand and how long the patient should be exempted from work. The goal of this review is to determine whether there are any standardized, evidence-based recommendations for postoperative care from which valid recommendations for Germany can be derived. METHODS We systematically searched the literature for evidence-based recommendations on exertion avoidance after abdominal surgery, as well as for information on the extent to which postoperative abdominal wall stress contributes to incisional hernia formation. We then created a questionnaire on recommendation practices and sent it to all of the chiefs of general and visceral surgery services that were listed in the German hospital registry (1078 chiefs of service as of June 2016). RESULTS All 16 of the included studies on postoperative exertion avoidance contained low-level evidence that could only be used to formulate weak recommendations ("can," rather than "should" or "must"). Some 50 000 incisional hernia repair procedures are performed in Germany each year, with a reported incidence of 12.8% in the first two years after surgery. The scientifically documented risk factors for incisional herniation are related to techniques of wound closure, the suture materials used, wound infections, and the patient risk profile. From the biological point of view, the abdominal wall regains full, normal resistance to exertional stress 30 days after a laparotomy with uncomplicated healing. Most incisional hernias (>50%) arise 18 months or more after surgery; they are more common in patients who have avoided exertion for longer periods of time (more than 8 weeks). Our questionnaire was returned by 386 surgical clinics. The responses showed that 78% of recommendations were based on personal experience only. The recommendations varied widely; exertion avoidance was recommended for as long as 6 months. CONCLUSION The dilemma of a deficient evidence base for postoperative exertion avoidance to protect the abdominal wall should be resolved with the much higher-quality evidence available from hernia research, which concerns the patient population with the biologically least favorable starting conditions. Based on our analysis of the available literature in light of the biomechanical principles of abdominal wall healing, we propose a new set of recommendations on postoperative exertion avoidance after abdominal surgery, with the goal of eliminating excessively protracted exertion avoidance and enabling a timely return to work.
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Affiliation(s)
- Christoph Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, German Society for General and Visceral Surgery (DGAV), Koblenz, Germany
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Lai LWH, Roslani AC, Yan YW, Bhojwani KM, Jamaluddin MFH. Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: a double-blind randomized controlled trial. ANZ J Surg 2021; 91:896-901. [PMID: 33522667 DOI: 10.1111/ans.16567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conventional mass closure uses suture-to-wound length ratio of 4:1 ('long stitch', LS). 'Short stitch' (SS) has a suture-to-wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post-operative pain after laparotomy closure using LS and SS. METHODS Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post-operative patient-controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi-squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann-Whitney U-test. RESULTS Eighty-six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient-controlled analgesia morphine usage 24 h post-operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P = 0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P = 0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P = 0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P = 0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference. CONCLUSION There were no differences in post-operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome.
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Affiliation(s)
| | - April Camilla Roslani
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Yang-Wai Yan
- Department of Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Kavita M Bhojwani
- Department of Anaesthesiology and Critical Care, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
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Pereira Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser JJ, Pera-Román M, López-Cano M. Small bites technique for midline laparotomy closure: From theory to practice: Still a long way to go. Surgery 2021; 170:140-145. [PMID: 33455821 DOI: 10.1016/j.surg.2020.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The closure technique of the abdominal wall is a key factor in the development of incisional hernia. Our aim was to implement a protocol for closure of median laparotomy, to evaluate the grade of implementation, as well as to assess the results and safety of the technique. METHODS A series of formative activities to implement the small bites technique for closure of median laparotomy in elective operations were designed. After 1 year, a survey was conducted on knowledge and use of the technique. Prospective compilation of data of all median laparotomy in elective operations and their follow-up was done for 1 year. The incidence of incisional hernia depending on the fulfilment of the protocol was compared. RESULTS A total of 74 surgeons participated in the activities. All the participants accomplished the technique perceiving low difficulty (1.9/10). After 1 year, 44 surgeons answered the survey; 95% stated that they knew the small bites technique and used it always or almost always, but only 52% performed the calculation of the suture length and the incision length ratio. A total of 114 median laparotomy in elective operations were analyzed; among them, 30.7% were closed with small bites presenting a lower frequency of incisional hernia and burst abdomen (small bites 3.6% vs large bites 12.1%; odds ratio 1.30; confidence interval, 0.992--1.711; P = .20). CONCLUSION The measures were effective for learning, but education alone was not enough to implement the technique in the real scenario. Small bites technique is reproducible, has no risks, and provides low incidence of incisional hernia. More incentives and actions are needed to improve laparotomy closure.
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Affiliation(s)
- José Antonio Pereira Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona.
| | | | - Alejandro Bravo-Salva
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona
| | - Blanca Montcusí-Ventura
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain
| | - J J Sancho-Insenser
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Surgery, Universitat Autónoma de Barcelona
| | - Miguel Pera-Román
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Surgery, Universitat Autónoma de Barcelona
| | - Manuel López-Cano
- Department of Surgery, Universitat Autónoma de Barcelona; Department of General and Digestive Surgery, Hospital Valle de Hebrón, Barcelona
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Garcia-Urena MA. Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review. Hernia 2021; 25:13-22. [PMID: 33394256 DOI: 10.1007/s10029-020-02348-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. METHODS A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines. RESULTS Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. CONCLUSION Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.
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Affiliation(s)
- M A Garcia-Urena
- Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Prima H, Sofii I, Fauzi AR, Dachlan I, Gunadi. The impact of different suturing techniques for abdominal fascia closure on the Interleukin-6 expressions in Rattus norvegicus. BMC Res Notes 2020; 13:502. [PMID: 33126892 PMCID: PMC7602327 DOI: 10.1186/s13104-020-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Incisional hernia is a frequent complication of midline laparotomy. The suturing technique is an important determinant of the risk of developing an incisional hernia. Moreover, IL-6 has crucial roles in the wound-healing process. We aimed to compare the large stitch vs. small stitch technique for abdominal fascial closure on IL-6 expressions in rats. RESULTS Twenty rats were used. The small stitch group received small tissue bites of 5 mm and the large stitch group received large bites of 10 mm. The incisions of fascia were closed by running sutures. Animals were euthanized on days 4 and 7. Histological sections of the tissue-embedded sutures were analyzed for IL-6 expressions. Two-way ANOVA showed that rats in the small stitch group had similar IL-6 expressions on days 4 and 7 to those in the large stitch group (p = 0.36). In conclusion, the IL-6 expressions are similar between the small and the large stitch groups, implying that different suturing techniques might not have an impact on the incisional hernia occurrence.
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Affiliation(s)
- Heryu Prima
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Imam Sofii
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Ishandono Dachlan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Verkade ME, Suthers J, Wiemer P, Martens A, De Clercq E, Burford J. Ultrasonographic evaluation of the width, thickness, and length of the normal linea alba in standing and dorsal recumbent horses. Vet Surg 2020; 50:158-169. [PMID: 33043994 DOI: 10.1111/vsu.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the variability in length, width, and thickness of the equine linea alba (LA) and the effect of a standing vs dorsal recumbent position on these measurements. STUDY DESIGN Descriptive anatomical comparative study. ANIMALS Standing horses (N = 75; in 30 horses, measurements were obtained in dorsal recumbency first and repeated after horses were standing). METHODS Linea alba length was measured in standing position from xiphoid to umbilicus, and transverse ultrasonographic images were obtained at five reference points to measure LA width and thickness. In 30 horses, measurements were obtained in dorsal recumbency first and repeated after horses were standing. RESULTS There was wide variation in LA width and thickness between standing horses, with gradual increase from xiphoid (range, 0.14-0.64 cm) to umbilicus (range, 0.2-2.97 cm). Linea alba length in standing position was 51.09 ± 6.219 cm. Width was independent of the size of the horse; thickness and length were correlated at some reference points to height (r = 0.346-585, P < .05) and weight (r = 0.324-0.642, P < .05). Different LA shapes could be identified. In dorsal recumbency, the LA was smaller in width at all reference points (15%-23%, P < .05) and shorter (20%, P < .001) compared with standing. CONCLUSION In addition to the wide variability in LA measurements and shapes between horses, there was a significant decrease in LA width and length when horses changed from standing to dorsal recumbency. CLINICAL SIGNIFICANCE The difference in LA length and width between dorsal recumbency and when standing could increase tension on sutures after laparotomy and should be taken into account when surgeons are closing the abdomen.
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Affiliation(s)
- Maria E Verkade
- De Lingehoeve Diergeneeskunde, Lienden, the Netherlands.,B&W Equine Hospital, Gloucestershire, United Kingdom
| | | | - Peter Wiemer
- De Lingehoeve Diergeneeskunde, Lienden, the Netherlands.,Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ann Martens
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva De Clercq
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - John Burford
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom
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Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity-matched study in large ventral hernias. Surg Endosc 2020; 35:4653-4660. [PMID: 32780243 DOI: 10.1007/s00464-020-07894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The merits of laparoscopic (LVHR) and open preperitoneal ventral hernia repair (OPPVHR) have been debated for more than 2 decades. Our aim was to determine peri-operative and long-term outcomes in large hernias. METHODS A prospective, institutional database at a tertiary hernia center was queried for patients undergoing LVHR and OPPVHR. One-to-one propensity score matching was performed for hernia defect size and follow-up. RESULTS Three hundred and fifty-two LVHR and OPPVHR patients were identified with defect sizes closely matched between laparoscopic (182.0 ± 110.0 cm2) and open repairs (178.3 ± 99.8 cm2), p = 0.64. LVHR and OPPVHR patients were comparable: mean age 57.2 ± 12.1 vs 56.6 ± 12.0 years (p = 0.52), BMI: 32.9 ± 6.6 vs 32.0 ± 7.4 kg/m2 (p = 0.16), diabetes 19.0% vs 19.7% (p = 0.87), and smoking history 8.7% vs 23.0% (p < 0.001), respectively. OPPVHR had higher number of recurrent hernias (14.2% vs 44.9%, p < 0.001), longer operative time (168.1 ± 64.3 vs 186.7 ± 67.7 min, p = 0.006), and more components separation (0% vs 20.3%, p < 0.001). Mean mesh size was larger (p < 0.001) in the open group (634.4 ± 243.4 cm2 vs 841.8 ± 277.6 cm2). The hernia recurrence rates were similar (10.8% vs 9.2%, p = 0.62), with average follow-up of 39.3 ± 32.5 vs 40.0 ± 35.0 months (p = 0.89). Length of stay was higher in the OVHR cohort (5.4 ± 3.0 vs 6.3 ± 3.6 days, p < 0.001), but 30-day readmission rates (4.0% vs 6.4%, p = 0.31) were similar. Overall wound infection rate (2.9% vs 8.4%, p = 0.03) was higher in the OPPVHR group, but the mesh infection rate was similar between LVHR (1.7%) and OPPVHR (0.6%) (p = 0.33). Postoperative pain (41.1% vs 41.4%, p = 0.95) and overall QOL based on the Carolinas Comfort Scale at 6 months (p = 0.73) and 5-years (p = 0.36) were similar. CONCLUSION Laparoscopic and open preperitoneal repair for large ventral hernias have equivalent hernia recurrence rates, postoperative pain, and QOL on long-term follow-up. Patients undergoing OPPVHR were more likely to be recurrent, complex, require components separation, and more likely to develop postoperative wound complications.
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Sugarbaker PH. Observations on opening and closing the abdominal incision for cytoreductive surgery using a self-retaining retractor to reduce the incidence of incisional hernia. Surg Oncol 2020; 35:5-11. [PMID: 32771958 DOI: 10.1016/j.suronc.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/18/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cytoreductive surgery for resection of peritoneal metastases requires an incision from the xyphoid process to the pubic rami. Laboratory and clinical data from randomized trials have shown that small (0.5-1.0 cm) bites of a running suture closely spaced (0.5 cm) through an isolated midline fascia results in the lowest incidence of incisional hernia. METHODS Manuscripts were used to formulate criteria for optimal closure of a long midline abdominal incision. Using these conclusions as a starting point, surgical technology to achieve an optimal wound closure were formulated. RESULTS A fixed retractor was placed prior to performing an abdominal incision. Skin traction sutures elevate the skin and subcutaneous tissue to facilitate fascial incision directly through the linea alba. Peritoneum and preperitoneal fat beneath the posterior rectus sheath are resected. Separations of the anterior and posterior rectus sheath are repaired prior to fascial closure. When closing the incision, a running suture of closely spaced small bites is used to bring the fascial edges together in the absence of excess tension. During closure of the fascia exposure of the linea alba with the skin traction sutures facilitates accurate placement of fascia only sutures. CONCLUSIONS Optimal exposure of abdominal wall structures while opening and closing a long midline abdominal incision will minimize the incidence of incisional hernia. A fixed retractor and skin traction sutures are required.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
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Weatherall KM, Boone LH, Caldwell FJ, Cole RC, Cattley RC, Lascola KM, Clark-Price SC, Farag R, Perkins E, Hanson RR. Tensile strength and early healing of self-locking and surgeon's knots. Vet Surg 2020; 49:1580-1589. [PMID: 32780444 DOI: 10.1111/vsu.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/07/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the biomechanical properties and healing of ventral midline celiotomies (VMC) closed with a self-locking knot combination and forwarder start and Aberdeen end (F-A) vs a traditional knot combination and surgeon's start and end (S-S). STUDY DESIGN In vivo, experimental. ANIMALS Twenty-one horses. METHODS Fourteen horses underwent VMC, which was closed with either an F-A (n = 7) or an S-S (n = 7) knot combination. Incisions were subjectively graded by masked evaluators for dehiscence, edema, and drainage. Biomechanical testing was performed on three abdominal segments, and histology was performed on one segment from each animal after humane euthanasia 10 days post-VMC. The abdominal wall of control horses (n = 7, no celiotomy) was collected for biomechanical testing. RESULTS Forwarder start and Aberdeen end and S-S horses had less tensile strength compared with control horses (P ≤ .001). No differences were detected between treatment groups for any variable evaluated, including tensile strength (P = .975), location of failure (P = .240), and histologic healing at the knot (P = .600). CONCLUSION Closure of VMC with self-locking knots resulted in biomechanical and healing features similar to those with a traditional closure technique, with neither restoring the tensile strength of the linea alba. CLINICAL SIGNIFICANCE Results of this study provide evidence to support a clinical trial to evaluate long-term performance of the F-A self-locking knot closure in horses.
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Affiliation(s)
- Kathleen M Weatherall
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Lindsey H Boone
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Fred J Caldwell
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Robert C Cole
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Russell C Cattley
- Department of Pathobiology, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Kara M Lascola
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Stuart C Clark-Price
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Ramsis Farag
- Center for Polymer and Advanced Composites, Auburn University Samuel Ginn College of Engineering, Auburn, Alabama, USA.,Department of Textile Engineering, Mansoura University, Mansoura, Egypt
| | - Edmon Perkins
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - R Reid Hanson
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
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Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties. Hernia 2020; 25:345-352. [PMID: 32770366 DOI: 10.1007/s10029-020-02280-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower transverse incisions. METHODS All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online questionnaire was sent to consultant obstetricians/gynecologists and colorectal surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines. RESULTS A total of 252 (64.5%) consultants provided a complete response to the survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin. CONCLUSION We found significant variation in abdominal wall closure techniques in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further studies.
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Reina Rodriguez FS, Milgram J, Kirby BM. Small vs. Large Suture Bite-to-Stitch Interval for Closure of Midline Celiotomy in Cats: A Biomechanical Study. Front Vet Sci 2020; 7:206. [PMID: 32391388 PMCID: PMC7188759 DOI: 10.3389/fvets.2020.00206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to compare the bursting strength and characterize the mode of failure of cranial and caudal midline celiotomies closed with 2 suture patterns and an absorbable monofilament suture material. Design: Randomized, cadaveric, ex- vivo mechanical testing. Sample: Feline cadavers (n = 32). Methods: Specimens were randomized into two groups based on the closure technique (small 2 × 2 mm or large 5 × 5 mm suture-bite-stitch-interval [SBSI] groups). Cranial or caudal midline celiotomies, 7.5 cm long, were created. A custom-made polyurethane bladder was inserted into the abdomen, and the celiotomies were closed in a simple continuous pattern using 3-0 polydioxanone. The repair was loaded to failure by inflating the bladder with compressed air. Bursting strength and mode of failure were recorded. Effects of body weight, gender, thickness and width of linea alba, suture-bite-stitch-interval, and location of celiotomy were analyzed using a mixed model analysis and an independent t- test, with P < 0.05 considered statistically significant. Results: There was no difference in bursting strength between cranial and caudal celiotomies. Bursting strength was lower for celiotomies closed with a large SBSI (P = 0.003). Bursting strength was greater in males compared to females (P = 0.003). Twenty five specimens failed distant from celiotomy closure, while 4 failed by fascial tearing at the site of needle penetration. Failure by loosening of the suture line with intact knots only occurred in 3 caudal celiotomies closed with a large SBSI. Gender, body weight and SBSI accounted for 61.5% of variability in bursting strength (P = 0.005). Conclusions: Small SBSI technique was mechanically superior to large SBSI when tested under these loading conditions. Clinical relevance: Supraphysiological pressures were required to cause failure in all specimens. Both small and large SBSI may be clinically applicable for midline celiotomy closure in domestic cats.
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Affiliation(s)
| | - Joshua Milgram
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Barbara M Kirby
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Standardized Surgical Primary Repair for Burst Abdomen Reduces the Risk of Fascial Redehiscence. Ann Surg 2020; 274:e1115-e1118. [PMID: 32209894 DOI: 10.1097/sla.0000000000003766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether a standardized surgical primary repair for burst abdomen could lower the rate of fascial redehiscence. SUMMARY BACKGROUND DATA Burst abdomen after midline laparotomy is associated with increased morbidity and mortality. The surgical treatment is poorly investigated but known for a poor outcome with high rates of re-evisceration (redehiscence). METHODS This study was a single-center, interventional study comparing rates of fascial redehiscence after surgery for burst abdomen in a study cohort (July 2014-April 2019) to a historical cohort (January 2009-December 2013). A standardized surgical strategy was introduced for burst abdomen: The abdominal wall was closed using a slowly absorbable running suture in a mass closure technique with "large bites" of 3 cm in "small steps" of 5 mm, in an approximate wound-suture ratio of 1:10. Demographics, comorbidities, preceding type of surgery, and surgical technique were registered. The primary outcome was fascial redehiscence. The secondary outcome was 30- and 90-day mortality. RESULTS The study included 186 patients with burst abdomen (92 patients in the historical cohort vs 94 patients in the study cohort). No difference in sex, performance status, comorbidity, or body mass index was found. In 77% of the historical cohort and 80% of the study cohort, burst abdomen occurred after emergency laparotomy (P = 0.664). The rate of redehiscence was reduced from 13% (12/92 patients) in the historical cohort to 4% (4/94 patients) in the study cohort (P = 0.033). There was no difference in 30- or 90-day mortality. CONCLUSION Standardized surgical primary repair for burst abdomen reduced the rate of fascial redehiscence.
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Shao JM, Alimi Y, Houlihan BK, Fabrizio A, Bayasi M, Bhanot P. Incisional Hernias After Major Abdominal Operations: Analysis Within a Large Health Care System. J Surg Res 2020; 249:130-137. [PMID: 31935568 DOI: 10.1016/j.jss.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This will be the largest multi-institutional study looking at incidence of and duration to symptomatic hernia formation for major abdominal operations separated by malignant and benign disease process. METHODS An IRB-approved retrospective study within the MedStar Hospital database was conducted, incorporating all isolated colectomy, hepatectomy, pancreatectomy, and gastrectomy procedures between the years 2002 and 2016. All patients were identified using ICD-9 and ICD-10 codes for relevant procedures, and then separated based on malignant or benign etiology. The rate of symptomatic incisional hernia rates was determined for each cohort based on subsequent hernia procedural codes identified. RESULTS During this 15-year span, a total of 6448 major abdominal operations were performed at all 10 institutions, comprising 3835 colectomies, 1122 hepatectomies, 1165 pancreatectomies, and 326 gastrectomies. Total incidence of symptomatic incisional hernia occurrence requiring repair was 325 (5.0%). Separated by group, the overall incisional hernia repair rates for patients undergoing colectomy, hepatectomy, pancreatectomy, and gastrectomy are as follows, respectively: 6.4% (247), 2.5% (28), 3.6% (42), and 2.8% (9), P < 0.0001. The subsequent median duration to hernia repair was 498 d (interquartile range [IQR]: 312-924) for colectomy, 421 d (IQR: 340-518) for hepatectomy, 378 d (IQR: 284-527) for pancreatectomy, and 630 d (IQR: 419-1204) for gastrectomy (P = 0.03401). CONCLUSIONS Symptomatic incisional hernia repair rates after major gastrointestinal and hepatobiliary surgery range from 2.1% to 6.4%. There was no significant increase in hernia rates in patients undergoing surgery for malignancy.
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Affiliation(s)
- Jenny M Shao
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Yewande Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Brenna K Houlihan
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Anne Fabrizio
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Mohammed Bayasi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Parag Bhanot
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia.
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Laparotomy closure techniques: Do surgeons follow the latest guidelines? Results of a questionnaire. Int J Surg 2019; 71:110-116. [DOI: 10.1016/j.ijsu.2019.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/25/2019] [Accepted: 09/19/2019] [Indexed: 02/07/2023]
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Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections. Hernia 2019; 24:839-843. [PMID: 31254134 DOI: 10.1007/s10029-019-01995-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. METHODS Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. RESULTS A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). CONCLUSION Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.
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Abstract
Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons.
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Retraction of the edge of rectus sheath after midline laparotomy. Asian J Surg 2019; 42:890-891. [PMID: 31113692 DOI: 10.1016/j.asjsur.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022] Open
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Suture length to wound length ratio in 175 small animal abdominal midline closures. PLoS One 2019; 14:e0216943. [PMID: 31107892 PMCID: PMC6527205 DOI: 10.1371/journal.pone.0216943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/01/2019] [Indexed: 11/19/2022] Open
Abstract
Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.
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Helgeland J, Tomic O, Hansen TM, Kristoffersen DT, Hassani S, Lindahl AK. Postoperative wound dehiscence after laparotomy: a useful healthcare quality indicator? A cohort study based on Norwegian hospital administrative data. BMJ Open 2019; 9:e026422. [PMID: 30948604 PMCID: PMC6500227 DOI: 10.1136/bmjopen-2018-026422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Postoperative wound dehiscence (PWD) is a serious complication to laparotomy, leading to higher mortality, readmissions and cost. The aims of the present study are to investigate whether risk adjusted PWD rates could reliably differentiate between Norwegian hospitals, and whether PWD rates were associated with hospital characteristics such as hospital type and laparotomy volume. DESIGN Observational study using patient administrative data from all Norwegian hospitals, obtained from the Norwegian Patient Registry, for the period 2011-2015, and linked using the unique person identification number. PARTICIPANTS All patients undergoing laparotomy, aged at least 15 years, with length of stay at least 2 days and no diagnosis code for immunocompromised state or relating to pregnancy, childbirth and puerperium. The final data set comprised 66 925 patients with 78 086 laparotomy episodes from 47 hospitals. OUTCOMES The outcome was wound dehiscence, identified by the presence of a wound reclosure code, risk adjusted for patient characteristics and operation type. RESULTS The final data set comprised 1477 wound dehiscences. Crude PWD rates varied from 0% to 5.1% among hospitals, with an overall rate of 1.89%. Three hospitals with statistically significantly higher PWD than average were identified, after case mix adjustment and correction for multiple comparisons. Hospital volume was not associated with PWD rate, except that hospitals with very few laparotomies had lower PWD rates. CONCLUSIONS Among Norwegian hospitals, there is considerable variation in PWD rate that cannot be explained by operation type, age or comorbidity. This warrants further investigation into possible causes, such as surgical technique, perioperative procedures or handling of complications. The risk adjusted PWD rate after laparotomy is a candidate quality indicator for Norwegian hospitals.
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Affiliation(s)
- Jon Helgeland
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Oliver Tomic
- Department of Mathematic Sciences and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Tonya Moen Hansen
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Sahar Hassani
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Anne Karin Lindahl
- Division of Surgery, Akershus University Hospital Trust, Lørenskog, Norway
- Department of Health Administration and Health Economics, University of Oslo, Oslo, Norway
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Fischer JP, Harris HW, López-Cano M, Hope WW. Hernia prevention: practice patterns and surgeons' attitudes about abdominal wall closure and the use of prophylactic mesh. Hernia 2019; 23:329-334. [PMID: 30734888 DOI: 10.1007/s10029-019-01894-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/15/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The penetration of hernia prevention techniques into surgical practice remains unknown. METHODS A survey about knowledge/attitudes on hernia prevention was sent to the members of hernia societies. RESULTS The 497 respondents were mostly from the US (47%) or Europe (40%). Most reported practicing, but not measuring their suture-to-wound length closure of > 4:1 (63%) and practicing but not measuring the number of stitches (58%). Reasons for not using short stitch closure were: does not apply to patient population (19%), not familiar enough with methods to correctly execute (25%), takes too long (13%), not reimbursed (4%), concerned about closure-related complications (27%), and other (22%). Regarding prophylactic mesh, respondents stated they were not familiar with literature (11%), familiar with literature but would not use (24%), familiar with literature and interested in use (45%), familiar with literature and using (15%), and other (5%). CONCLUSIONS There appears to be some application of hernia prevention principles related to fascial closure; however, the use of prophylactic mesh still appears to be controversial.
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Affiliation(s)
- J P Fischer
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - H W Harris
- Department of Surgery, University of California, San Francisco, CA, USA
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - W W Hope
- Department of Surgery, New Hanover Regional Medical Center, 2131 South 17th Street, PO Box 9025, Wilmington, NC, 28401, USA.
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