Page 56 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 3
Table 3: Secondary outcome parameters
Patients with postoperative complications - n (%)
Ileus - n (%)
Pneumonia - n (%)
Cardiac event - n (%)
Surgical Site Infection (SSI) - n (%) • Super cial Incisional SSI* • Deep incisional SSI*
• Organ/space SSI*
Burst abdomen - n (%)
Length of hospital stay (days) – mean (SE)
Large bites group (n=284)
129 (45%)
33 (12%)
40 (14%)
30 (11%)
68 (24%) 33 (12%) 12 (4%) 23 (8%)
2 (1%) 14 (24)
Small bites group (n=276)
125 (45%)
28 (10%) 35 (1%) 25 (9%)
58 (21%) 23 (8%) 8 (3%) 27 (10%)
4 (1%) 15 (35)
p value
1•000
0•590 0•710 0•573
0•419 0•207 0•496 0•554
0•444 0•585
*detailed criteria for SSIs can be found in the published study protocol(13).
Discussion
Our ndings show that suturing of the fascia after abdominal midline incision with a continuous small bites technique reduces the incidence of incisional hernia compared with suturing with the conventional large bites technique. The small bites technique with a single suture USP 2-0 is a safe technique in view of the low incidence of burst abdomen, and is easily learnt and performed with the small needle(15). With a mean additional closure time of 4 min, the small bites technique is not very time consuming; additionally, the technique is not associated with a di erence in postoperative pain. Our results are generalisable to the general surgical population in view of the participation of residents and specialists of vascular, general, gastrointestinal and gynaecological surgical specialties.
Although the Swedish trial(10) was the rst prospective trial comparing large and small bites, this study had methodological limitations. Patients were quasi-randomised (alternated per calendar week) and radiological examination of the abdominal wall was not done. As a diagnostic technique for the presence of incisional hernia, ultrasonography has a reported sensitivity of 70–98%; physical examination has a reported sensitivity of 58–74% in diagnosis of incisional hernia(21, 22). Furthermore, in 16–28% of patients with complaints of discomfort at their scar, but without a palpable defect during physical examination, an incisional hernia was diagnosed by ultrasonography(21, 22). Because almost half of incisional hernias in the present trial were diagnosed
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