title: Incisional hernia after midline laparotomy: a prospective study.
abstract: OBJECTIVE
  To study the healing of midline laparotomy wounds.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  County hospitals, Sweden and Iceland.
  
  
  METHODS
  861 patients who underwent midline laparotomy between August 1989 and November 1992. 453 of whom were operated on during the first 20 months, and 408 of whom were operated on during the second 20 months after surgeons had been asked to adjust their technique to achieve a suture length: wound length ratio of more than 4.
  
  
  METHODS
  Wound dehiscence, wound infection, and incidence of incisional hernia at 12 months.
  
  
  RESULTS
  78/861 patients (9%) developed wound infection. This incidence correlated with previous midline laparotomy and degree of wound contamination. Mean (SD) suture length: wound length ratio increased from 3.6 (1.3) in the first period to 4.9 (1.6) during the second period (p < 0.01), as a result of a reduction in the stitch interval from 1.2 (0.2)-0.9 (0.2) cm (p < 0.01). All other recorded variables were comparable in both study periods. The rate of incisional hernia decreased from 19% (68 of 363) during the first period to 11% (35 of 320) during the second period (p < 0.01). Suture length: wound length ratio < 4, wound infection and age 60 years or more were significantly and independently associated with an increased incidence of incisional hernia.
  
  
  CONCLUSIONS
  Suture technique is a major determinant of incisional hernia in continuously sutured midline laparotomies. Simple adjustments in technique can considerably improve late operative results.
authors.affiliation: Department of Surgery, Sundsvall County Hospital, Sweden.
authors.forename: L A
authors.initials: LA
authors.lastname: Israelsson
authors.forename: T
authors.initials: T
authors.lastname: Jonsson
mesh_terms: D005260:Female; D006547:Hernia / Q000209:etiology*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013536:Suture Techniques; D014945:Wound Healing