José Antonio Pereira Rodríguez1, Sara Amador-Gil2, Alejandro Bravo-Salva3, Blanca Montcusí-Ventura4, J J Sancho-Insenser5, Miguel Pera-Román5, Manuel López-Cano6. 1. Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona. Electronic address: jpereira@parcdesalutmar.cat. 2. Department of Surgery, Universitat Autónoma de Barcelona. 3. Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona. 4. Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain. 5. Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Surgery, Universitat Autónoma de Barcelona. 6. Department of Surgery, Universitat Autónoma de Barcelona; Department of General and Digestive Surgery, Hospital Valle de Hebrón, Barcelona.
Abstract
BACKGROUND: The closure technique of the abdominal wall is a key factor in the development of incisional hernia. Our aim was to implement a protocol for closure of median laparotomy, to evaluate the grade of implementation, as well as to assess the results and safety of the technique. METHODS: A series of formative activities to implement the small bites technique for closure of median laparotomy in elective operations were designed. After 1 year, a survey was conducted on knowledge and use of the technique. Prospective compilation of data of all median laparotomy in elective operations and their follow-up was done for 1 year. The incidence of incisional hernia depending on the fulfilment of the protocol was compared. RESULTS: A total of 74 surgeons participated in the activities. All the participants accomplished the technique perceiving low difficulty (1.9/10). After 1 year, 44 surgeons answered the survey; 95% stated that they knew the small bites technique and used it always or almost always, but only 52% performed the calculation of the suture length and the incision length ratio. A total of 114 median laparotomy in elective operations were analyzed; among them, 30.7% were closed with small bites presenting a lower frequency of incisional hernia and burst abdomen (small bites 3.6% vs large bites 12.1%; odds ratio 1.30; confidence interval, 0.992--1.711; P = .20). CONCLUSION: The measures were effective for learning, but education alone was not enough to implement the technique in the real scenario. Small bites technique is reproducible, has no risks, and provides low incidence of incisional hernia. More incentives and actions are needed to improve laparotomy closure.
BACKGROUND: The closure technique of the abdominal wall is a key factor in the development of incisional hernia. Our aim was to implement a protocol for closure of median laparotomy, to evaluate the grade of implementation, as well as to assess the results and safety of the technique. METHODS: A series of formative activities to implement the small bites technique for closure of median laparotomy in elective operations were designed. After 1 year, a survey was conducted on knowledge and use of the technique. Prospective compilation of data of all median laparotomy in elective operations and their follow-up was done for 1 year. The incidence of incisional hernia depending on the fulfilment of the protocol was compared. RESULTS: A total of 74 surgeons participated in the activities. All the participants accomplished the technique perceiving low difficulty (1.9/10). After 1 year, 44 surgeons answered the survey; 95% stated that they knew the small bites technique and used it always or almost always, but only 52% performed the calculation of the suture length and the incision length ratio. A total of 114 median laparotomy in elective operations were analyzed; among them, 30.7% were closed with small bites presenting a lower frequency of incisional hernia and burst abdomen (small bites 3.6% vs large bites 12.1%; odds ratio 1.30; confidence interval, 0.992--1.711; P = .20). CONCLUSION: The measures were effective for learning, but education alone was not enough to implement the technique in the real scenario. Small bites technique is reproducible, has no risks, and provides low incidence of incisional hernia. More incentives and actions are needed to improve laparotomy closure.
Authors: J A Pereira-Rodríguez; S Amador-Gil; A Bravo-Salva; B Montcusí-Ventura; J Sancho-Insenser; M Pera-Román; M López-Cano Journal: Hernia Date: 2021-11-01 Impact factor: 2.920