Page 101 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

EHS guidelines
Statement
It is recommended that prospective randomized studies assessing the technique to close abdominal wall incisions use the same suture material in both study groups.
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Continuous suturing versus interrupted sutures
Both meta-analyses concluded that continuous suturing for closure of midline laparotomies was bene cial compared to interrupted closure (4, 48). Diener et al.(4) found a signi cant lower incisional hernia rate for continuous suturing (OR 0.59: p = 0.001) in elective surgery. Most of the included studies were at high risk of bias because the interrupted study arm used rapidly absorbable multi lament sutures and the continuous arm used either non-absorbable or slowly absorbable mono lament sutures. van’t Riet et al.(48) included studies involving emergency laparotomies and did not nd any di erence in incisional hernia rate between interrupted and continuous suturing. Continuous suturing was recommended because it was signi cantly faster.
Closure versus non-closure of the peritoneum
The Cochrane review by Gurusamy et al.(62) concluded that there was no short- term or long-term bene t in peritoneal closure. Five studies were included but were heterogeneous in type of incision (midline and non-midline) and included both elective and emergency laparotomies. In all studies the peritoneum was closed as a separate layer in the study arm with peritoneal closure.
Mass closure versus single layer closure
The search for the most appropriate layers to be sutured when closing a laparotomy is hampered by the lack of good de nitions on what constitutes a
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Statement
Continuous suturing for closure of midline abdominal wall incisions in elective surgery is recommended
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Statement
Closure of the peritoneum as a separate layer during closure of laparotomy incisions is NOT recommended
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