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


METHODS
Twelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75-95%, overall agreement 50-75%, no consensus <50%.


RESULTS
157 out of 599 patients were eligible for analysis (85 (54%) midline, 54 (35%) transverse incisions). After midline incisions the fascia was closed continuously in 55 patients (65%), using slowly absorbable (n = 47, 55%), braided (n = 32, 38%) sutures with a strength of 1 (n = 48, 57%). In the transverse setting the fascia was closed continuously in 39 patients (72%) with slowly absorbable (n = 22, 41%) braided sutures (n = 27, 50%) with a strength of 1 (n = 30, 56%).


CONCLUSIONS
In the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group) is performed on a consensus level.
Rahbari
Nuh N
NN
Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany. nuh.rahbari@med.uni-heidelberg.de
Knebel
Phillip
P
Diener
Markus K
MK
Seidlmayer
Christoph
C
Ridwelski
Karsten
K
Stöltzing
Hartmut
H
Seiler
Christoph M
CM
D034861:Abdominal Wall / Q000601:surgery*; D032921:Consensus; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques / Q000592:standards*