Page 80 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 4
Secondary outcome – surgical site infection, wound dehiscence/burst abdomen, suture sinus
Various criteria were used for de nition of SSI ranging from the de nition by Center of Disease Control and Prevention with the classi cation into super cial, deep and organ/space infection to the surgeon’s clinical assessment of the wound. Wound dehiscence and burst abdomen was poorly de ned by the majority of the studies. Wound dehiscence seemed to include both skin dehiscence with intact fascia and fascial disruption. In the meta-analysis, we de ned burst abdomen as cases where a fascial dehiscence was described. Only one study reported that SSI was more common after emergency laparotomy compared with elective laparotomy(27). Several studies found that the development of an incisional hernia was preceded by a SSI in up to 40% of the cases(25-29).
There were no signi cant di erences on SSI and burst abdomen, when comparing the use of non-absorbable, slowly-absorbable and fast-absorbable sutures. Further, there were no di erences on SSI and burst abdomen using a continuous or interrupted suture technique. Millbourn et al.(25) reported signi cantly fewer SSIs when using a small bites suture technique, however, Deerenberg et al.(4) found no signi cant di erences on SSI between small and big bites technique (Figure 8). There were no signi cant di erences regarding burst abdomen between small and big bites technique(4, 25).
Suture sinus formation, palpable knots and wound pain was reported to be a problem with the use of non-absorbable sutures as compared with fast- and slowly-absorbable sutures in several studies(19, 21, 23, 26, 28), whereas only one study found no signi cant di erences on suture sinus between non- absorbable and slowly-absorbable sutures(20).
Discussion
The results of this systematic review and meta-analysis show that a small bites continuous suture technique with a slowly-absorbable polydioxanone (PDS) small sized suture decreases the incisional hernia rate compared to a large bite technique with a larger suture. There were no signi cant di erences on incisional hernia rate when comparing non-absorbable, slowly-absorbable and fast absorbable sutures using the same suture technique. Furthermore, using an interrupted or continuous suture technique with the same kind of suture material did not a ect incisional hernia rate.
78