title: Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures.
abstract: BACKGROUND
  Incisional hernia remains among the most common complications after midline incision of the abdominal wall. The role of the suture material used for abdominal wall closure remains controversial. To decrease bacterial adherence to surgical sutures, braided suture materials with antibacterial activity (Vicryl plus, Ethicon, Inc) were developed. This is the first study to analyze long-term results using an antibacterial-braided suture material for abdominal wall closure in a large clinical trial.
  
  
  METHODS
  To analyze the effects of Triclosan-coated suture material (Vicryl plus) on the development of incisional hernia, we performed a 36-month follow-up of 1,018 patients who had a primary midline incision for elective abdominal surgery. In the first time period, a PDS II loop suture was used. In the second observation period, we used Vicryl plus. All variables were recorded prospectively in a database. The primary outcome was the number of incisional hernias. Risk factors for the development of incisional hernias were collected prospectively to compare the 2 groups.
  
  
  RESULTS
  The overall incisional hernia rate in the 36-month follow-up period was 14.6%. Analyzing the influence of the suture material used on the development of incisional hernia, we did not find differences between the 2 groups (PDS II, 14%; Vicryl plus, 15.2%). In the multivariate analysis of possible factors in the study population, only body mass index (BMI) showed a significant influence on the development of incisional hernias. Despite the incidence of wound infections being less in the Vicryl plus group (6.1% vs 11.9%; P < .05), there were no difference in incidence of incisional hernia between the 2 groups.
  
  
  CONCLUSIONS
  Fast absorbable sutures with antibacterial coating (Tricosan) do not increase the hernia rate after midline abdominal incision compared with slowly absorbable sutures, when wound infection rates are decreased by coating the fast absorbable suture with Triclosan. The development of incisional hernia is significantly increasing in patients with a BMI >30 kg/m(2).
authors.affiliation: Department of General, Visceral, Vascular and Paediatric Surgery, University of the Saarland, Homburg/Saar, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Justinger
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Slotta
authors.forename: Martin Karl
authors.initials: MK
authors.lastname: Schilling
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects*; D000042:Absorption; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D020099:Coated Materials, Biocompatible; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016687:Polydioxanone / Q000009:adverse effects; D011098:Polyglactin 910 / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D013537:Sutures / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D016687:Polydioxanone; D011098:Polyglactin 910