Page 348 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 18
no signi cant di erences between suture materials regarding the incidence of IH were found. When using the same suture material, the ‘small bites’ technique had a signi cantly lower rate of IH than the ‘large bites’ technique. No signi cant di erences were found between the continuous ‘large bites’ technique and a technique with interrupted sutures.
In Chapter 5, the European Hernia Society (EHS) guidelines on the closure of abdominal wall incisions are reported on. In these guidelines, it is recommended to close a midline incision with a continuous suture technique; to avoid fast-absorbable sutures; to perform fascial closure in one layer; and to not close the peritoneum separately. It is advised to use a slowly-absorbable suture and a ‘small bites’ technique, with a suture to wound length ratio of at least 4:1.
In Chapter 6, the incidence of IHs, and their correlation with parastomal hernias (PSH), is explored through examination of a cross-sectional study of 150 patients with left-sided colostomies. Patients with a PSH were found to have a 7-times greater occurrence of midline IH. Most of the IHs developed at the level of the colostomy.
In Chapter 7, the possible causes of the increased incidence of IH reported in Chapter 6 are further investigated. Seventy-seven patients with both a preoperative and postoperative abdominal CT-scan were selected from the cross-sectional study. The CT-scans of these patients were uploaded to the I-Space® system and three-dimensionally visualized and projected using V-scope® software. In the I-Space®, shift in the linea alba and thickness of the abdominal rectus muscles were measured. A thinner abdominal rectus muscle was found in patients with PSH, compared to those without. Furthermore, a shift of the midline to the right was found after colostomy creation. Both observations change the forces on the healing linea alba and likely contribute to the development of IH.
Part 2. Surgical treatment of incisional hernia
In the second part of this thesis, research on the surgical treatment of IH is presented.
In Chapter 8, the results of a systematic review on the surgical repair of IH are presented. Since evidence from RCTs was scarce, a meta-analysis
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