Page 48 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 3
Introduction
Incisional hernia is a frequent complication of abdominal operations with an incidence of 10–23%, which can increase to 38% in speci c risk groups(1-4). In the USA 4 million to 5 million laparotomies are done annually, suggesting that at least 400 000–500 000 incisional hernias can be expected to occur every year. Incisional hernia is associated with pain and discomfort, resulting in a decreased quality of life(5).Moreover, incarceration and strangulation of abdominal contents can take place, for which emergency surgery is indicated, with associated morbidity and mortality(6). About 348000 operations for incisional hernia are done every year in the USA with US$3•2 billion in annual associated costs(7). Prevention of incisional hernia is therefore of paramount importance. Several suturing techniques for abdominal closure after a midline abdominal incision have been studied in the past few decades. Findings from meta-analyses have shown that a running technique with long-lasting mono lament suture material reduces the incidence of incisional hernia compared with interrupted suture techniques(3, 8). Nowadays, most surgeons, urologists, and gynaecologists use the running closure technique with large tissue bites to close midline incisions(9). In 2009, a study from Sweden(10) showed that a running suture technique with small tissue bites, developed by Israelsson, decreased the incidence of incisional hernia compared with a running suture technique with large tissue bites. In this study, small tissue bites were de ned as placement of a stitch every 5–8 mm from the wound edge. This promising technique is contradictory to old surgical principles and needs to be thoroughly investigated before it can be widely implemented(11, 12). We did the STITCH study to compare the common conventional large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions.
Methods
Study design
We did this prospective, multicentre, double-blind, randomised controlled trial at surgical and gynaecological departments in ten hospitals in the Netherlands. The trial protocol has been previously published(13). Patients aged 18 years
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