Page 28 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 2
of incisional hernia may be higher because the stitch tends to slacken, which allows wound edges to separate.
Small stitches, placed 4–6 mm from the wound edge, only cut through the aponeurosis and not through the rectus abdominis muscle. Recent experimental data show that the small bites technique results in stronger wounds and faster healing than the routine large bite technique(33). Our experiments in a porcine model showed a 47% increase in breaking strength when small bites were used compared to the routine technique(32). A recent randomized of randomised clinical study by Millbourn et al. reported a decrease of incidence of incisional hernia of 70% 18% to 5.6%, p<0.001) and a decrease of 50%, (10.2% to 5.2%, p=0.020) of wound infection (34, 35). These results are very promising with regard to the prevention of incisional hernia and wound infection. The bene ts of this technique need to be con rmed in a multicenter double-blinded randomized controlled trial.
In daily practice, most surgeons in the Netherlands use the large bite technique with large suture distances. With large bites, SL:WL ratio depends on the thickness of the abdominal wall including the muscles, the bite size, the number of stitches and the traction on the sutures during suturing. With large bites, an unanswered question remains with regard to how the SL:WL ratio of 4 should be reached. With a low traction force, fewer stitches are needed, but the slacking e ect during the postoperative period may in uence results.
With small stitches, SL:WL ratio is mostly dependent on the number of stitches. There is no su cient evidence to prefer one suture closure technique over the other in order to prevent incisional hernia and fascia dehiscence.
Objective
The objective of the STITCH trial (Suture Techniques to reduce the Incidence of The inCisional Hernia) is to compare the small bites technique described by Millbourn et al. with a standardized large bites technique.
The overall objective of the study is reduction of the incidence of the most frequent complication of abdominal surgery, i.e., incisional hernia. We hypothesize that the small bites technique will result in a signi cant reduction of the incidence of incisional hernia, which may lead to a reduced morbidity and a better quality of life for patients and a signi cant reduction of costs.
Primary endpoint will be incisional hernia occurrence within one year after surgery, either clinically and/or ultrasonographically detected. Secondary
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