Current practice of abdominal wall closure in elective surgery – Is there any consensus?

Rahbari, Nuh N.; Knebel, Phillip; Diener, Markus K.; Seidlmayer, Christoph; Ridwelski, K.; Stöltzing, H.; Seiler, Christoph M.

doi:10.1186/1471-2482-9-8

Cited by 72 publications

(48 citation statements)

References 18 publications

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“…Prophylactic routine placement of subcutaneous drains after laparotomy is occasionally used to decrease wound complications: infection, hematoma, seroma or wound dehiscence [86]. However, there are several disadvantages to the routine use of subcutaneous drains.…”

Section: Subcutaneous Drains In Laparotomy Incisionsmentioning

confidence: 99%

“…Postoperative management and instructions for patients are not supported by high quality prospective data, but rely mostly on surgeons' habits, tradition and common beliefs [86][87][88]. Long-term follow-up studies are needed to research the impact on the occurrence of incisional hernias of prescribing abdominal binders or restricting postoperative activity.…”

Section: Postoperative Carementioning

confidence: 99%

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European Hernia Society guidelines on the closure of abdominal wall incisions

Muysoms

Antoniou

Bury

et al. 2015

Hernia

510

406

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Section: Subcutaneous Drains In Laparotomy Incisionsmentioning

confidence: 99%

Section: Postoperative Carementioning

confidence: 99%

European Hernia Society guidelines on the closure of abdominal wall incisions

Muysoms

Antoniou

Bury

et al. 2015

Hernia

510

406

View full text Add to dashboard Cite

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“…22 Another study echoed that staples are clearly considered a suitable method for vertical abdominal wounds. 8 A different study gave its verdict that there was no clear benefit from the use of staples in closure of abdominal wounds.…”

Section: Discussionmentioning

confidence: 99%

Abdominal skin incision closure with non-absorbable sutures versus staples- a comparative study

Muthukumar¹,

Venugopal²,

Subramaniam³

2017

Int Surg J

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Background: Bacterial smartness and innovations have clearly outsmarted and drained the antibiotic discovery pipelines of pharmaceutical brains throughout the globe. Postoperative infection is a major cause of antibiotic use. The aim of the study was to compare the effects of using non-absorbable suture materials and staples for abdominal skin incision closure in terms of the occurrence rate of surgical site infections, the level of comfort experienced by patient and the cosmetic acceptability of scar by the patient.Methods: A randomized control study conducted at the general surgical department of a tertiary hospital in Southern India. The final scores of the study in the categories of surgical site infection, pain and cosmesis were analyzed using Students t-test or Anova test.Results: The use of staples to close skin incision in laparotomy cases reduces surgical site infection, improves the perception of cosmetic appearance of scar to the patient and adds to the comfort of patient by reducing the pain experienced by the patient. The subgroup of population who may comprehensively benefit are patients below 40 years, middle and high socio economic status population, clean and clean contaminated surgeries where incision length is more than 5cm.Conclusions: The results of this study illustrated the fact that the use of staples in closure of skin incision in laparotomy case especially in selected subgroup of population significantly reduces the surgical site infection, hence slashing the use of antibiotics and in turn has the potential to reduce the incidence of antibiotic resistance.

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“…3 This heterogeneity of behavior has led many authors to standardize abdominal wall closure procedures. 4,6 If the process of standardization has achieved satisfactory results in the elective surgery setting as demonstrated by recent international guidelines of the European hernia society with the introduction of globally accepted slowly absorbable running suture as gold standard for abdominal wall closure, shortage of solid evidence leaves the emergency setting an unexplored field.…”

Section: Discussionmentioning

confidence: 99%

Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

et al. 2017

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Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

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Current practice of abdominal wall closure in elective surgery – Is there any consensus?

Abstract: Background: Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery.

Cited by 72 publications

References 18 publications

European Hernia Society guidelines on the closure of abdominal wall incisions

European Hernia Society guidelines on the closure of abdominal wall incisions

Abdominal skin incision closure with non-absorbable sutures versus staples- a comparative study

Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

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