EFFECTIVENESS OF ABDOMINAL WALL CLOSURE STRATEGIES IN THE PREVENTION OF POST-LAPAROTOMY INCISIONAL HERNIAS
DOI:
https://doi.org/10.56238/levv16n55-094Keywords:
Laparotomy, Incisional Hernia, Abdominal Wall Closure, Suture, Systematic ReviewAbstract
Introduction: Incisional hernias are among the most frequent and costly complications following laparotomy, significantly impacting postoperative morbidity and patient quality of life. Various abdominal wall closure strategies have been investigated to prevent their occurrence. Objective: To evaluate the effectiveness of abdominal wall closure techniques in preventing incisional hernias after laparotomy, through a systematic review of the literature. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Embase, Scopus, Cochrane Library, and Web of Science. Randomized clinical trials, systematic reviews, and guidelines addressing closure techniques and incisional hernia outcomes were included. Study quality was assessed using GRADE and SIGN tools. Results: A total of 52 studies were included. Techniques using small-bite sutures, triclosan-coated threads, and prophylactic mesh application in high-risk patients emerged as the most effective in reducing incisional hernia incidence. Conclusion: Optimal abdominal wall closure requires integration of technical precision, appropriate materials, and individualized patient risk assessment. Evidence-based strategies are essential to improve surgical outcomes and prevent long-term complications.
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AHLQVIST, S.; EDLING, A.; ALM, M.; DACKHAMMAR, J. B.; NORDIN, P.; CENGIZ, Y. Trocar site hernia after gastric sleeve. Surgical Endoscopy, v. 36, p. 4386–4391, 2022.
ALBERTSMEIER, M. et al. Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial. Hernia, v. 26, p. 87–95, 2022.
ANTONIOU, S. A. et al. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia, v. 20, p. 1–10, 2016.
BOSANQUET, D. C. et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One, v. 10, p. e0138745, 2015.
BROUWERS, M. C. et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, v. 182, p. E839–E842, 2010.
CANO-VALDERRAMA, O. et al. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure? Surgical Endoscopy, v. 34, p. 4048–4052, 2020.
DE BEAUX, A. C. Abdominal wall closure. British Journal of Surgery, v. 106, n. 3, p. 163–164, 2019.
DEERENBERG, E. B. et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet, v. 386, p. 1254–1260, 2015.
DEERENBERG, E. B. et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. British Journal of Surgery, v. 109, n. 12, p. 1239–1250, 2022.
GILLION, J. F.; SANDERS, D.; MISEREZ, M.; MUYSOMS, F. The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia, v. 20, p. 819–830, 2016.
GRAT, M. et al. Incisional surgical site infections after mass and layered closure of upper abdominal transverse incisions: first results of a randomized controlled trial. Annals of Surgery, v. 274, p. 690–697, 2021.
GUYATT, G. H. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, v. 336, p. 924–926, 2008.
HENRIKSEN, N. A. et al. Meta-analysis on materials and techniques for laparotomy closure: the MATCH review. World Journal of Surgery, v. 42, p. 1666–1678, 2018.
HENRIKSEN, N. A. et al. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis. Hernia, v. 21, p. 833–841, 2017.
HOER, J. et al. Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirurg, v. 73, p. 474–480, 2002.
HOLIHAN, J. L. et al. Adverse events after ventral hernia repair: the vicious cycle of complications. Journal of the American College of Surgeons, v. 221, p. 478–485, 2015.
ISRAELSSON, L. A.; JONSSON, T. Suture length to wound length ratio and healing of midline laparotomy incisions. British Journal of Surgery, v. 80, p. 1284–1286, 1993.
ISRAELSSON, L. A.; MILLBOURN, D. Prevention of incisional hernias: how to close a midline incision. Surgical Clinics of North America, v. 93, p. 1027–1040, 2013.
JAIRAM, A. P. et al. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open, v. 4, p. 357–368, 2020.
KÖSSLER-EBS, J. B. et al. Incisional hernia rates after laparoscopic or open abdominal surgery—a systematic review and meta-analysis. World Journal of Surgery, v. 40, p. 2319–2330, 2016.
LEE, L. et al. Incisional hernia after midline versus transverse specimen extraction incision: a randomized trial in patients undergoing laparoscopic colectomy. Annals of Surgery, v. 268, p. 41–47, 2018.
MILLBOURN, D.; CENGIZ, Y.; ISRAELSSON, L. A. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Archives of Surgery, v. 144, p. 1056–1059, 2009.
MUYSOMS, F. E. et al. European Hernia society guidelines on the closure of abdominal wall incisions. Hernia, v. 19, p. 1–24, 2015.
PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, p. n71, 2021.
WU, X. et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. European Journal of Clinical Microbiology & Infectious Diseases, v. 36, p. 19–32, 2017.
