Page 65 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
Incisional hernia is a frequent problem after abdominal surgery with an incidence varying from 10% to 69% depending on the type of surgery, length and method of follow-up and patient characteristics(1-5). Incisional hernias develop due to insu cient healing of the abdominal wall after surgery. The defect in the abdominal wall allows for protrusion of intra-peritoneal content causing a variety of symptoms ranging from discomfort and impaired body image to incarceration and ischemia of the contents of the hernia sac. Besides signi cant morbidity and impaired quality of life, incisional hernias are costly to treat(6, 7). Well-known patient related risk factors for incisional hernia formation are smoking, obesity, relaparotomy and postoperative wound complications(8, 9). Additionally, the suture material and the surgical technique used to close a laparotomy wound are important surgical determinants of the risk of developing an incisional hernia. To reduce the incidence of incisional hernia, an international group of experts developed the European Hernia Society guidelines on the closure of abdominal wall incisions(10). The recommendations in this guideline for closure of midline incisions included a continuous suture technique, performed with a small bites technique and a slowly-absorbable suture material. These recommendations were mainly based on the evidence from systematic reviews on the subject(11-13). However, the randomized controlled trials (RCTs) included in these reviews generally compare a continuous suture technique with a slowly- or non-absorbable suture to an interrupted suture technique with a fast-absorbable suture. A comparison limited to those studies evaluating only one variable between study arms (same technique performed with di erent suture materials or di erent techniques performed with same suture material) was not performed. It was the hypothesis that in order to evaluate a certain suture material or technique, the same suture material should be used in both arms with various techniques and vice versa. Therefore this systematic review and meta-analysis was done to assess the evidence from published RCTs comparing closure materials or techniques for laparotomies with a primary outcome of incisional hernia after 12 months and with secondary outcomes of surgical site infection (SSI) and burst abdomen.
4
MATCH review
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