Page 88 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
Abstract
Background
The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimizing closure of abdominal wall incisions holds a potential to prevent patients su ering from incisional hernias and for important costs savings in health care.
Methods
The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) and methodological guidance was taken from SIGN (Scottish Intercollegiate Guidelines Network). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017.
Results
For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendations could be made due to lack of su cient evidence.
Recommendations
To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable mono lament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current preferred method of fascial closure. Currently, no recommendations
86