Page 100 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
are often completely contradictory. The overall quality of most systematic reviews is low and therefore, several should be rejected as evidence to create guidelines. A major problem to identify the evidence from the literature is the fact that most prospective studies compared several variables between the study arms. Moreover, the populations studied are often very di erent: midline only or including other incisions, emergency or elective surgery, and di erent operative indications.
The current guidelines on techniques and materials are based on the systematic reviews by Diener et al.(4) and van’t Riet et al.(48) which were evaluated as High Quality. Both systematic reviews included only studies involving midline laparotomies and the review by Diener et al. was the only one to distinguish between elective or emergency surgery. The systematic review by Sajid et al.(43) was used for the question on suture materials and a recent Cochrane review by Gurusamy et al.(62) was used for the question on peritoneal closure.
Using separate PICO’s the shortcoming of many study designs to deliver clear answers becomes obvious. Another shortcoming in most studies on closure of laparotomies is the failure to monitor the technical details of the suturing technique, like the SL/WL ratio and the stitch size. As demonstrated by Israelsson(64) this might be an important confounding factor in studies comparing di erent suture materials. An updated systematic review taking into account the mentioned shortcomings of individual studies might be performed, but for these guidelines the conclusions are based on the data from the currently available systematic reviews. The protocol for an ongoing Cochrane review(65) was published in 2006 but the nal data have not yet been published.
Statement
It is recommended that prospective randomized studies on the suture material to close abdominal wall incisions use the same suturing technique in both study groups.
strong
98