Miniaturized Sensors Registering the Long-Term Course of Suture Tension In Vivo under Varying Intra-Abdominal Pressure

Abstract

Background: Failure of laparotomy closure develops after up to 20% of abdominal operations. Suture tension has an influence on the quality of tissue regeneration. No sensors are available to register suture tension dynamics in vivo. Methods: In a series of animal experiments, the effect of suture tension on the ultrastructure of the healing incision was examined. Surgeons’ ability to suture with target tension was tested. An implantable sensor and data logger were developed and tested experimentally in sutures closing midline laparotomies in pigs both under normal and elevated intra-abdominal pressure. Results: High suture tension has a negative influence on the regeneration of laparotomy incisions. Running sutures for laparotomy closure lose 45% of their initial tension over periods of 23 h. Intermittent elevation of intra-abdominal pressure to 30 mm Hg leads to a near total loss of suture tension after 23 h. Conclusion: Surgeons are not able to control and reproduce suture tension. Suture tension dynamics can be measured in vivo by the sensor developed. Further research is needed to define a tissue-specific suture tension optimum to reduce the incidence of complications after laparotomy. Techniques for laparotomy closure need to be modified.

Measurement of Closure Forces During Abdominal Wall Closure as a New Parameter for Incisional Hernia Prevention: an Experimental Animal Study

“…Twenty-seven female pigs underwent a midline laparotomy. Group A had a mean weight of 21.6 kg (20)(21)(22)(23)(24); group B of 50.2 kg (43-54,5) and group C of 98.5 kg (95-102). Confounding variables, like the abdominal circumference, thickness of the fascia and length of the laparotomy, showed statistical differences, but not so the width of the fascia.…”

“…Studies about closure tension are limited. Some authors have described results in human cadavers [16][17][18], some in experimental settings [19][20][21] and others in patients with incisional hernias [22,23], but none have described the tension of the closure forces during an abdominal wall closure. Jenkins et al [5] described a mechanical approach to the burst abdominal wound, considering there is a 30% of sutured wound stretch after abdominal distension.…”

The Best Closure Technique Without Mesh in Elective Midline Laparotomy Closure

“…Therefore, verification of the applied suture tension seems to be an absolute problem. A study by Höer et al ( 23 ) and Schachtrupp et al ( 24 ) measured suture tension under simulation of fascial closure. The results of the surgeons involved were sobering regarding the specifications and reproducibility.…”