Page 57 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

solely during radiological examination, our results attest that radiological imaging is essential to assess the presence of incisional hernia. Guidelines on the closure of abdominal wall incisions from the European Hernia Society strongly recommend that prospective studies with incisional hernias as a primary outcome should integrate medical imaging in the follow-up(2, 9, 18, 21). In our trial, roughly three-quarters of patients received radiological imaging during follow-up. Some patients had such an obvious clinical incisional hernia that imaging would have added no extra information. In some patients, radiological imaging was not done, either because patients were visited at home or because of local logistical di culties. We considered achievement of standardisation to be important. Two major parameters were standardised: the technique of small and large bites and the target number of stitches per running cm of wound length, resulting in an appropriate ratio of suture length to wound length.
Our study has some limitations. Our primary analysis was done after 1 year of follow-up. Previous studies(2, 4) have shown that incidence of incisional hernia increases during longer follow-up. Our follow-up of both clinical and radiological examination resulted in an incidence of 21% in the large bites group. These results are similar to those of other groups with longer follow-up(2, 4). Because radiological examination was done for the diagnosis of incisional hernia, small incisional hernias could have been diagnosed that would not have been detected by physical examination. We feel that the diagnosis of these smaller hernias explains the fairly high incidence in both groups at 1 year and might translate into a smaller increase in new hernias during longer follow- up. We do not expect that the e ectiveness of the small bites will be a ected with longer follow-up.
Another limitation might be that our results do not di erentiate between an e ect of the smaller bites or the use of di erent suture material. In this trial, we investigated the small bites technique described by Israelsson(14). For the small bites technique the UPS 2-0 PDS Plus II (Ethicon) single suture thread with a 31 mm needle was used, whereas the large bites procedure was done with a thicker PDS 1 loop with a 48 mm needle. Therefore, analysis of whether the small bites or the thinner needle and suture material reduces the incisional hernias in the small bites group needs further research.
We included only patients undergoing elective surgery. Evidence about the best closure technique in emergency laparotomy incisions is scarce, even in the EHS guidelines no recommendation is given(9). Whether results obtained
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STITCH trial
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