Page 106 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
by Diener et al. showed a signi cant decrease in surgical site infection (OR 0.67: CI 0.47–0.98). No data on incisional hernias are available from these studies.
Statement
Mono lament sutures impregnated with antibiotics for closure of elective midline incisions is NOT advised, because of insu cient data on their e ciency on prevention of surgical site infections and the lack of data on incisional hernias or burst abdomen.
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Limitations of the statements in these guidelines on suture technique and suture materials
The statements are limited by the quality of the data on which they are based. In total, 61 RCT’s have been identi ed that compared suture materials or techniques to close laparotomy incisions. Many studies have more than one variable between study arms and therefore analysing them in meta-analyses is di cult. Moreover, many studies have aws in the methodology increasing the risk of bias. We would like to encourage researchers that plan studies on abdominal wall closure to improve the methodology of their study protocol. Preferably study arms are only di erent in the variable under investigation, either a suture technique or a suture material. Moreover we recommend documenting the technical details such as SL/WL ratio, the number of stitches used in the patients and to provide a follow up of at least 24 months.
Although some of the systematic reviews detected included non-midline incisions(43) or emergency operations(48), these guidelines are currently limited to elective midline laparotomies. For emergency operations and non- midline incisions there is currently not enough data available.
Statement
No recommendation on suture material or suturing technique for use in emergency surgery can be given due to lack of su cient data.
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