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The healing of laparotomies: A bibliographic study Part two: Technical aspects

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Summary

The closure of laparotomies continues to be the source of complications such as abscess of the abdominal wall, the formation of granulomas and sinuses, and above all evisceration and incisional hernia. Despite technologic progress as regards sutures, the evisceration rate has remained unchanged since the 19505. The aim of this bibliographic study is to analyze the factors that risk disturbing the healing of laparotomies, so as to establish which are the best techniques for opening and closing the abdominal wall and to provide the best guide to the choice of suture material. Midline incisions seem preferable and should be closed by a continuous suture in an single layer, passed at least 1.5 cm from the margins to the incision, with a thread four times as long. The abdominal wall only regains its mechanical functions of resistance to a significant degree after the 4th postoperative month. No absorbable suture material currently on the market is capable of maintaining adequate resistance during this critical period. Even though clinical studies do not for the greater part allow us to associate a particular type of suture with a more or less high risk of evisceration or incisional hernia, it seems logical to use a nonabsorbable material or a suture that is very slowly absorbed for patients with factors favoring these complications.

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  1. Laboratoire d'Anatomie et de Chirurgie Expérimentale, 74, rue Marcel Cachin, F-93017, Bobigny cedex, France

    A. M. Rath & J. P. Chevrel

  2. Service de Chirurgie Digestive, Hôpital Avicenne, Bobigny, France

    J. P. Chevrel

  3. Fondation Martine Midy, France

    A. M. Rath

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Rath, A.M., Chevrel, J.P. The healing of laparotomies: A bibliographic study Part two: Technical aspects. Hernia 4, 41–48 (2000). https://doi.org/10.1007/BF01230593

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