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Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties

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Abstract

Purpose

Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower transverse incisions.

Methods

All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online questionnaire was sent to consultant obstetricians/gynecologists and colorectal surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines.

Results

A total of 252 (64.5%) consultants provided a complete response to the survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin.

Conclusion

We found significant variation in abdominal wall closure techniques in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further studies.

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Funding

No external funding was received.

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Authors and Affiliations

  1. Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    C. B. Paulsen, D. Zetner & J. Rosenberg

Authors
  1. C. B. Paulsen
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  2. D. Zetner
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  3. J. Rosenberg
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Corresponding author

Correspondence to C. B. Paulsen.

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Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

Ethical approval was sought but not deemed necessary by the Ethics Committee in Denmark.

Human and animal rights

There are no human and animal rights issues to declare.

Informed consent

Potential participants were sent an information e-mail with the link to the questionnaire and informed about the nature and purpose of the study. The purpose of the survey was explained in the information e-mail. Only those willing to, completed and returned the questionnaires.

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Paulsen, C.B., Zetner, D. & Rosenberg, J. Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties. Hernia 25, 345–352 (2021). https://doi.org/10.1007/s10029-020-02280-w

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  • DOI: https://doi.org/10.1007/s10029-020-02280-w

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