Page 105 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Mono lament versus multi lament sutures
Mono lament sutures are believed to be associated with a lower SSI rate than multi lament sutures(12). However, none of the SRs commented on this issue speci cally. If the previous recommendation to use slowly absorbable sutures for closure of elective midline laparotomies is followed, this question becomes super uous because the slowly absorbable sutures are all mono lament sutures.
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Concerning the size of the suture, no studies comparing directly the size of the sutures used to close abdominal wall incisions were identi ed during our searches. For the “small bites” technique, Isrealsson et al(12) suggest to use a suture size USP 2/0 (USP = United States Pharmacopeia).
Sutures impregnated with antibiotics
Sutures coated with Triclosan as an antimicrobial agent have been introduced to decrease the rate of surgical site infection in surgery. A recent meta-analysis has demonstrated a signi cant bene cial e ect in the prevention of surgical site infection after all kinds of surgery(71). Surgical site infection is a risk factor for subsequent development of incisional hernias and therefore the use of antibiotics impregnated sutures to close laparotomies might be bene cial in the prevention of incisional hernias. Recently Diener et al.(72) published a large RCT on 1,224 patients undergoing an elective midline laparotomy comparing polydioxanone sutures with versus without triclosan impregnation. No reduction in the incidence of surgical site infection was reported (OR 0.91: CI 0.66–1.25; p = 0.39). Four other RCT’s have compared sutures with or without triclosan in laparotomy closure, either with polyglactin sutures (Vicryl)(73, 74) or with polydioxanone (PDS)(75, 76). A meta-analysis on all ve studies performed
EHS guidelines
Statement
We suggest using mono lament suture material for continuous closure of midline abdominal wall incisions in elective surgery.
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weak
Statement
No recommendation on the size of the sutures for closure of abdominal wall incisions can be given due to lack of data.
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no
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