Page 103 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Small bites versus large bites
Millbourn et al.(69) demonstrated that closure of a midline laparotomy with a “small bites” technique resulted in signi cant less incisional hernias (5.6% vs 18.0 %; p< 0.001) and less surgical site infections (SSIs) (5.2% vs 10.2%; p= 0.02). In the small bite technique the laparotomy wound is closed with a single layer aponeurotic suturing technique taking bites of fascia of 5 - 8 mm and placing stitches every 5 mm.
What is the optimal suture material to close a laparotomy incision?
Despite signi cant heterogeneity and confounders in most SRs identi ed, a study by Sajid et al.(43) focused solely on the suture material. Table 3 de nes the suture materials used in the included studies.
Rapidly absorbable suture versus non-absorbable or slowly absorbable sutures
Diener et al. (4) reported a signi cantly lower incisional hernia rate with slowly absorbable sutures (OR 0.65: p= 0.009) in elective surgery. Subgroup analysis performed by van ‘t Riet et al.(48) comparing only continuous suturing studies, detected only one RCT by Wissing et al.(70) using continuous suturing in both study arms. This study, which included 21% of emergency operations, showed signi cantly more incisional hernias with rapidly absorbable sutures compared to non-absorbable sutures (p= 0.001) and compared to slowly absorbable sutures (p = 0.009).
5
EHS guidelines
Statement
The“small bites technique”for continuous closure of midline incisions is suggested.
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weak
Statement
The use of rapidly absorbable suture material for closure of midline abdominal wall incisions in elective surgery is NOT recommended.
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strong
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