Page 107 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

EHS guidelines
Statement
No recommendation on suture material or suturing technique for use in non- midline incisions can be given due to lack of su cient data
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no
Suture needles and retention sutures
Blunt tip versus sharp needles
Only one SR assessing the type of needle used to close the abdominal wall(23) and one RCT comparing blunt needles with sharp needles were identi ed. The RCT reported no di erence in SSI rate between blunt and sharp needles(77).
Is there a place for retention sutures when closing a laparotomy?
No SR on the use of retention sutures was found. Eight records were screened by full text(78-85). Three RCTs on the prevention of burst abdomen by using either retention sutures or a reinforced tension line suture in patients with increased risk for wound dehiscence and burst abdomen were identi ed(78, 81, 85). Follow up was too short to evaluate incisional hernia rate. The Summary of Evidence is listed in Table 4. Two studies showed favourable results(78, 81), but one study reported a high number of adverse events when using retention sutures(85).
Postoperative care
Postoperative management and instructions for patients are not supported by high quality prospective data, but rely mostly on surgeons’ habits, tradition and common beliefs (86-88). Long term follow up studies are needed to research the impact on the occurrence of incisional hernias of prescribing abdominal binders or restricting postoperative activity. The additional searches did not reveal any relevant study on long term outcome. Some studies on the short term bene ts of abdominal binders were found.
5
Statement
No recommendation on the type or the size of needle to close a laparotomy can be given due to lack of data.
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no
Statement
No recommendation on the use of retention sutures in patients with multiple risk factors for burst abdomen can be given due to insu cient data.
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no
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