P Heger1,2, F Pianka1,2, M K Diener3,4, A L Mihaljevic1,2. 1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. 2. Studienzentrum der Deutschen Gesellschaft für Chirurgie (SDGC), Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. 3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. markus.diener@med.uni-heidelberg.de. 4. Studienzentrum der Deutschen Gesellschaft für Chirurgie (SDGC), Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. markus.diener@med.uni-heidelberg.de.
Abstract
BACKGROUND: The most frequent complications following midline abdominal laparotomy include incisional hernias, which develop in 10-15 % of patients and surgical site infections in 15-25 % of cases; however, the risk of these complications can be reduced by the surgical technique and the use of special suture materials. In 2010, the INLINE meta-analysis performed by the Study Centre of the German Society of Surgery (SDGC) revealed that a continuous suture technique using slowly absorbable suture material resulted in the lowest risk of developing postoperative incisional hernia after elective midline laparotomy. OBJECTIVE: The aim of this study was to perform a systematic literature search to identify all randomized controlled trials (RCTs) that have been published since 2010 concerning conventional abdominal wall closure in order to update the 2010 INLINE meta-analysis and summarize current evidence. MATERIAL AND METHODS: On 28 January 2016, a systematic literature search was performed in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). All RCTs dealing with abdominal wall closure after midline laparotomy were identified and included for further analysis. RESULTS: Since 2010 a total of 9 RCTs comparing different techniques of abdominal wall closure have been published. Three monocentric RCTs comparing different suture materials, showed no significant differences to the INLINE meta-analysis regarding incisional hernia development; therefore, slowly absorbable sutures using a continuous suture technique are still recommended for abdominal wall closure in elective cases. Furthermore, six RCTs were identified which investigated antimicrobial suture materials but failed to show an overall advantage for Triclosan-coated suture material with respect to surgical site infections. CONCLUSION: Current evidence shows that slowly absorbable monofilament suture material using a continuous suture technique provides the best results with regard to incisional hernia rates after elective midline laparotomy. Triclosan-coated sutures cannot be recommended as a standard suture material as they failed to reduce surgical site infections. For emergency laparotomies no evidence exists to recommend a specific kind of suture technique or a special suture material.
BACKGROUND: The most frequent complications following midline abdominal laparotomy include incisional hernias, which develop in 10-15 % of patients and surgical site infections in 15-25 % of cases; however, the risk of these complications can be reduced by the surgical technique and the use of special suture materials. In 2010, the INLINE meta-analysis performed by the Study Centre of the German Society of Surgery (SDGC) revealed that a continuous suture technique using slowly absorbable suture material resulted in the lowest risk of developing postoperative incisional hernia after elective midline laparotomy. OBJECTIVE: The aim of this study was to perform a systematic literature search to identify all randomized controlled trials (RCTs) that have been published since 2010 concerning conventional abdominal wall closure in order to update the 2010 INLINE meta-analysis and summarize current evidence. MATERIAL AND METHODS: On 28 January 2016, a systematic literature search was performed in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). All RCTs dealing with abdominal wall closure after midline laparotomy were identified and included for further analysis. RESULTS: Since 2010 a total of 9 RCTs comparing different techniques of abdominal wall closure have been published. Three monocentric RCTs comparing different suture materials, showed no significant differences to the INLINE meta-analysis regarding incisional hernia development; therefore, slowly absorbable sutures using a continuous suture technique are still recommended for abdominal wall closure in elective cases. Furthermore, six RCTs were identified which investigated antimicrobial suture materials but failed to show an overall advantage for Triclosan-coated suture material with respect to surgical site infections. CONCLUSION: Current evidence shows that slowly absorbable monofilament suture material using a continuous suture technique provides the best results with regard to incisional hernia rates after elective midline laparotomy. Triclosan-coated sutures cannot be recommended as a standard suture material as they failed to reduce surgical site infections. For emergency laparotomies no evidence exists to recommend a specific kind of suture technique or a special suture material.
Authors: Markus K Diener; Phillip Knebel; Meinhard Kieser; Philipp Schüler; Tobias S Schiergens; Vladimir Atanassov; Jens Neudecker; Erwin Stein; Henryk Thielemann; Reiner Kunz; Moritz von Frankenberg; Utz Schernikau; Jörg Bunse; Boris Jansen-Winkeln; Lars I Partecke; Gerald Prechtl; Julius Pochhammer; Ralf Bouchard; René Hodina; K Tobias E Beckurts; Lothar Leißner; Hans-Peter Lemmens; Friedrich Kallinowski; Oliver Thomusch; Daniel Seehofer; Thomas Simon; Alexander Hyhlik-Dürr; Christoph M Seiler; Thilo Hackert; Christoph Reissfelder; René Hennig; Colette Doerr-Harim; Christina Klose; Alexis Ulrich; Markus W Büchler Journal: Lancet Date: 2014-04-07 Impact factor: 79.321
Authors: André L Mihaljevic; Rebekka Schirren; Mine Özer; Stephanie Ottl; Sybille Grün; Christoph W Michalski; Mert Erkan; Carsten Jäger; Carolin Reiser-Erkan; Victoria Kehl; Tibor Schuster; Jürgen Roder; Ulf Clauer; Carolin Orlitsch; Tomas F Hoffmann; Reinhard Lange; Thomas Harzenetter; Phillip Steiner; Milena Michalski; Karl Henkel; Josef Stadler; Georg A Pistorius; Anja Jahn; Robert Obermaier; Robert Unger; Roland Strunk; Frank Willeke; Holger Vogelsang; Bert Halve; Karl-Heinz Dietl; Hendrik Hilgenstock; Alexander Meyer; Hans-Jörg Krämling; Markus Wagner; Michael H Schoenberg; Florian Zeller; Johannes Schmidt; Helmut Friess; Jörg Kleeff Journal: Ann Surg Date: 2014-11 Impact factor: 12.969
Authors: Christoph Justinger; Mohammed Reza Moussavian; Christian Schlueter; Berit Kopp; Otto Kollmar; Martin Karl Schilling Journal: Surgery Date: 2009-01-25 Impact factor: 3.982
Authors: Robert L Smith; Jamie K Bohl; Shannon T McElearney; Charles M Friel; Margaret M Barclay; Robert G Sawyer; Eugene F Foley Journal: Ann Surg Date: 2004-05 Impact factor: 12.969
Authors: Sebastian Hempel; Anne Kalauch; Florian Oehme; Steffen Wolk; Thilo Welsch; Jürgen Weitz; Marius Distler Journal: Medicine (Baltimore) Date: 2021-05-21 Impact factor: 1.817