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Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model

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Abstract

Purpose

Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting.

Methods

Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered.

Results

The highest tensile force was measured when using barbed polydioxanone (334.8 N ± 157.0), but differences did not reach statistical significance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008).

Conclusion

Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author.

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Funding

This study received no financial support from extramural sources.

Author information

Author notes

  1. M. Allaeys and L. Visscher contributed equally to the manuscript.

Authors and Affiliations

  1. Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium

    M. Allaeys, P. Dries, F. Berrevoet & H. H. Eker

  2. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

    L. Visscher, F. P. J. den Hartog & P. J. Tanis

  3. Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    L. Visscher & H. P. Theeuwes

  4. Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands

    H. P. Theeuwes

Authors
  1. M. Allaeys
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  2. L. Visscher
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  3. F. P. J. den Hartog
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Correspondence to M. Allaeys.

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Neither human nor live animal subjects were used in this study. As such, per local institutional guidelines, no ethical approval was needed.

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Allaeys, M., Visscher, L., den Hartog, F.P.J. et al. Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model. Hernia 28, 527–535 (2024). https://doi.org/10.1007/s10029-023-02945-2

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  • DOI: https://doi.org/10.1007/s10029-023-02945-2

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