Reduced Rate of Dehiscence After Implementation of a Standardized Fascial Closure Technique in Patients Undergoing Emergency Laparotomy

Abstract

The standardized procedure of closing the midline laparotomy by using a "small steps" technique of continuous suturing with a slowly absorbable (polydioxanone) suture material reduces the rate of fascial dehiscence.

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

“…42 That guideline is for elective procedures because in emergency operations, there is no high-quality evidence to recommend the best SL/WL ratio. However, in 2017, Tolstrup and colleagues 13 achieved SL/WL !4.0 in 95% of their cases and reduced the incidence of FD from 6.6% to 3.8% in a historical cohort.…”

“…[6][7][8][9][10] Despite advances in surgical material quality and operative techniques, the incidence of FD remains unchanged. [10][11][12] Recently, Tolstrup and colleagues 13 reported that the FD rate can be reduced in emergency operations by using a running suture length (SL) to wound length (WL) ratio of !4:1 and the small-bite technique.…”

The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice?

“…At 1 and 3 years after surgery, no difference in pain perception was observed between the groups). No difference in surgical site infections was observed, but time to complete wound healing of surgical site infection was significantly longer in patients with mesh implantation (median [interquartile range], 8 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] weeks compared with 5 [1-9] weeks; P = 0.03). Trunk extension was significantly decreased after mesh implantation compared with the control group.…”

“…Surgeons have been slow to recognise the burden of incisional hernia following laparotomy [9,10]. The incidence of incisional hernias is approximately 15% at one year, rising to 25% at three years (range 10-50%) [11].…”

Abdominal wall closure

“…Both trials excluded emergency surgery, as well as obese patients – the group that perhaps has the highest risk of incisional hernia. A Danish group used the small‐stitch, small‐bite technique in a large series of emergency midline laparotomies, with a marked reduction in the rate of burst abdomen compared with historical controls. The use of so‐called near and far (Hughes) stitches has also been described, but it too has not become common practice.…”