Page 64 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 4
Abstract
Introduction
The aim of this systematic review and meta-analysis was to evaluate the evidence from published randomized controlled trials (RCT) comparing closure materials or suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months and the secondary outcomes were burst abdomen and surgical site infection (SSI).
Materials and methods
A systematic computerized literature search was conducted using Medline, EMBASE, the Cochrane library, CINAHL, Scopus and Web-of Science including publications until May 2016. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists from SIGN. Meta-analyses were performed with Review Manager v5.3.
Results
A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms, that any suture material (fast absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing (OR = 1.20 ; 95%CI : 0.84, 1.71). For continuous suturing in elective midline closure, the small bites technique results in signi cantly less incisional hernias than a large bites technique (OR = 0.41 ; 95%CI : 0.19, 0.86).
Conclusion
No suture material or suture technique was proven superior. This allows us to choose a continues suture (faster) technique using a slowly absorbable suture and small bites (or small needle) for closure of a midline laparotomy.
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