Page 102 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
mass closure, layered closure or single layer closure. No clinical studies directly comparing di erent closure methods were found.
For future research the Guidelines Development Group proposes the following de nitions:
- mass closure: the incision is closed with a suture bite including all layers of the abdominal wall except the skin.
- layered closure: the incision is closed with more than one separate layer of fascial closure
- single layer aponeurotic closure: the incision is closed by suturing only the abdominal fascia in one layer.
Suture length to wound length ratio (SL/WL)
The bene cial e ect of a high SL/WL ratio on reducing the incidence of incisional hernias has been recognised for a long time(66), but evidence from clinical prospective studies remains scarce and most of the work addressing the topic comes from the Clinic of Sundsvall in Sweden(64, 67, 68). A RCT, performed in Sundsvall, demonstrated the importance of the SL/WL ratio in reducing incisional hernia rate. The critical value was determined to be at a ratio of 4/1(64). Although a SL/WL ratio ≥4 is often mentioned in the protocol of prospective studies, many fail to document that the SL/WL ratio was recorded for the individual study patients.
Statement
For closure of midline abdominal wall incisions in elective surgery, a single layer aponeurotic closure is suggested
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weak
Statement
A suture to wound length ratio (SL/WL) of at least 4/1 for continuous closure of midline abdominal wall incisions in elective surgery is suggested.
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weak
Statement
It is recommended that all prospective studies on the closure of laparotomy incisions will document the suture to wound length ratio (SL/WL) in all patients, as well as the number of stitches.
strong
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