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Textbook of Hernia pp 189–194Cite as

Hernia Prevention and the Importance of Laparotomy Closure

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Abstract

Incisional hernia remains a major complication after abdominal surgery associated with high morbidity and costs. Several risk factors have been identified. To reduce incisional hernia, attention should be paid to laparotomy closure. Closure should be performed using continuous sutures using mass closure with small bite size (5 mm) and 5 mm between stitches, resulting in a suture length to wound length ratio of ≥4. Absorbable suture material should not be chosen, slowly absorbable sutures are preferred. Prophylactic mesh augmentation is recommended in high-risk patients, like patients undergoing abdominal aortic aneurysm surgery or obese patients.

Onlay mesh position is as effective as sublay mesh position in preventing incisional hernia. For mesh augmentation, a synthetic mesh should be chosen.

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References

  1. Bevis PM, Windhaber RA, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC. Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg. 2010;97(10):1497–502.

    Article  CAS  PubMed  Google Scholar 

  2. Bloemen A, van Dooren P, Huizinga BF, Hoofwijk AG. Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure. Br J Surg. 2011;98(5):633–9.

    Article  CAS  PubMed  Google Scholar 

  3. Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010;251(5):843–56.

    Article  PubMed  Google Scholar 

  4. Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101(2):51–4.

    Article  CAS  PubMed  Google Scholar 

  5. Curro G, Centorrino T, Low V, Sarra G, Navarra G. Long-term outcome with the prophylactic use of polypropylene mesh in morbidly obese patients undergoing biliopancreatic diversion. Obes Surg. 2012;22(2):279–82.

    Article  PubMed  Google Scholar 

  6. Raffetto JD, Cheung Y, Fisher JB, Cantelmo NL, Watkins MT, Lamorte WW, et al. Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease. J Vasc Surg. 2003;37(6):1150–4.

    Article  PubMed  Google Scholar 

  7. Holland AJ, Castleden WM, Norman PE, Stacey MC. Incisional hernias are more common in aneurysmal arterial disease. Eur J Vasc Endovasc Surg. 1996;12(2):196–200.

    Article  CAS  PubMed  Google Scholar 

  8. Sugerman HJ, Kellum Jr JM, Reines HD, DeMaria EJ, Newsome HH, Lowry JW. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171(1):80–4.

    Article  CAS  PubMed  Google Scholar 

  9. van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg. 2012;204(2):144–50.

    Article  PubMed  Google Scholar 

  10. Nieuwenhuizen J, van Ramshorst GH, ten Brinke JG, de Wit T, van der Harst E, Hop WC, et al. The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia. 2011;15(3):297–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. van’t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350–6.

    Article  Google Scholar 

  12. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16(2):179–83.

    Article  CAS  PubMed  Google Scholar 

  13. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284(6320):931–3.

    Article  CAS  Google Scholar 

  14. Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg. 1997;163(3):175–80.

    CAS  PubMed  Google Scholar 

  15. Carlson MA. Acute wound failure. Surg Clin North Am. 1997;77(3):607–36.

    Article  CAS  PubMed  Google Scholar 

  16. Pollock AV, Greenall MJ, Evans M. Single-layer mass closure of major laparotomies by continuous suturing. J R Soc Med. 1979;72(12):889–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Lamont PM, Ellis H. Incisional hernia in re-opened abdominal incisions: an overlooked risk factor. Br J Surg. 1988;75(4):374–6.

    Article  CAS  PubMed  Google Scholar 

  18. Carlson MA, Ludwig KA, Condon RE. Ventral hernia and other complications of 1,000 midline incisions. South Med J. 1995;88(4):450–3.

    Article  CAS  PubMed  Google Scholar 

  19. Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgensen LN. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140(2):119–23.

    Article  PubMed  Google Scholar 

  20. Ellis H, Bucknall TE, Cox PJ. Abdominal incisions and their closure. Curr Probl Surg. 1985;22(4):1–51.

    Article  CAS  PubMed  Google Scholar 

  21. Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, et al. A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg. 2015;263:1010–7.

    Article  Google Scholar 

  22. Fassiadis N, Roidl M, Hennig M, South LM, Andrews SM. Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair. Br J Surg. 2005;92(10):1208–11.

    Article  CAS  PubMed  Google Scholar 

  23. Takagi H, Sugimoto M, Kato T, Matsuno Y, Umemoto T. Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vasc Endovasc Surg. 2007;33(2):177–81.

    Article  CAS  PubMed  Google Scholar 

  24. Busuttil RW, Abou-Zamzam AM, Machleder HI. Collagenase activity of the human aorta. A comparison of patients with and without abdominal aortic aneurysms. Arch Surg. 1980;115(11):1373–8.

    Article  CAS  PubMed  Google Scholar 

  25. Powell JT, Adamson J, MacSweeney ST, Greenhalgh RM, Humphries SE, Henney AM. Influence of type III collagen genotype on aortic diameter and disease. Br J Surg. 1993;80(10):1246–8.

    Article  CAS  PubMed  Google Scholar 

  26. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg. 2001;14(1):47–54.

    Article  CAS  PubMed  Google Scholar 

  27. Henriksen NA, Yadete DH, Sorensen LT, Agren MS, Jorgensen LN. Connective tissue alteration in abdominal wall hernia. Br J Surg. 2011;98(2):210–9.

    Article  CAS  PubMed  Google Scholar 

  28. Bickenbach KA, Karanicolas PJ, Ammori JB, Jayaraman S, Winter JM, Fields RC, et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg. 2013;206(3):400–9.

    Article  PubMed  Google Scholar 

  29. Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev. 2005;4:CD005199.

    Google Scholar 

  30. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1–24.

    Article  CAS  PubMed  Google Scholar 

  31. Mayer AD, Ausobsky JR, Evans M, Pollock AV. Compression suture of the abdominal wall: a controlled trial in 302 major laparotomies. Br J Surg. 1981;68(9):632–4.

    Article  CAS  PubMed  Google Scholar 

  32. Hoer JJ, Junge K, Schachtrupp A, Klinge U, Schumpelick V. Influence of laparotomy closure technique on collagen synthesis in the incisional region. Hernia. 2002;6(3):93–8.

    Article  CAS  PubMed  Google Scholar 

  33. Hoer J, Klinge U, Schachtrupp A, Tons C, Schumpelick V. Influence of suture technique on laparotomy wound healing: an experimental study in the rat. Langenbecks Arch Surg. 2001;386(3):218–23.

    Article  CAS  PubMed  Google Scholar 

  34. van Ramshorst GH, Nieuwenhuizen J, Hop WC, Arends P, Boom J, Jeekel J, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg. 2010;34(1):20–7.

    Article  PubMed  Google Scholar 

  35. Wissing J, van Vroonhoven TJ, Schattenkerk ME, Veen HF, Ponsen RJ, Jeekel J. Fascia closure after midline laparotomy: results of a randomized trial. Br J Surg. 1987;74(8):738–41.

    Article  CAS  PubMed  Google Scholar 

  36. Gupta H, Srivastava A, Menon GR, Agrawal CS, Chumber S, Kumar S. Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials. Asian J Surg. 2008;31(3):104–14.

    Article  PubMed  Google Scholar 

  37. Seiler CM, Bruckner T, Diener MK, Papyan A, Golcher H, Seidlmayer C, et al. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg. 2009;249(4):576–82.

    Article  PubMed  Google Scholar 

  38. Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63(11):873–6.

    Article  CAS  PubMed  Google Scholar 

  39. Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144(11):1056–9.

    Article  PubMed  Google Scholar 

  40. Israelsson LA. Bias in clinical trials: the importance of suture technique. Eur J Surg. 1999;165(1):3–7.

    Article  CAS  PubMed  Google Scholar 

  41. Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg. 1993;80(10):1284–6.

    Article  CAS  PubMed  Google Scholar 

  42. Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg. 2012;397(8):1201–7.

    Article  PubMed  Google Scholar 

  43. Weiland DE, Bay RC, Del Sordi S. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176(6):666–70.

    Article  CAS  PubMed  Google Scholar 

  44. Berretta R, Rolla M, Patrelli TS, Piantelli G, Merisio C, Melpignano M, et al. Randomised prospective study of abdominal wall closure in patients with gynaecological cancer. Aust N Z J Obstet Gynaecol. 2010;50(4):391–6.

    Article  PubMed  Google Scholar 

  45. DesCoteaux JG, Temple WJ, Huchcroft SA, Frank CB, Shrive NG. Linea alba closure: determination of ideal distance between sutures. J Invest Surg. 1993;6(2):201–9.

    Article  CAS  PubMed  Google Scholar 

  46. Harlaar JJ, van Ramshorst GH, Nieuwenhuizen J, Ten Brinke JG, Hop WC, Kleinrensink GJ, et al. Small stitches with small suture distances increase laparotomy closure strength. Am J Surg. 2009;198(3):392–5.

    Article  PubMed  Google Scholar 

  47. Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254–60.

    Article  PubMed  Google Scholar 

  48. Sajid MS, Parampalli U, Baig MK, McFall MR. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg. 2011;9(8):615–25.

    Article  CAS  PubMed  Google Scholar 

  49. Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027–40.

    Article  PubMed  Google Scholar 

  50. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83; discussion 83–5.

    PubMed  PubMed Central  Google Scholar 

  51. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.

    Article  CAS  PubMed  Google Scholar 

  52. Pans A, Desaive C. Use of an absorbable polyglactin mesh for the prevention of incisional hernias. Acta Chir Belg. 1995;95(6):265–8.

    CAS  PubMed  Google Scholar 

  53. Timmermans L, de Goede B, Eker HH, van Kempen BJ, Jeekel J, Lange JF. Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Dig Surg. 2013;30(4–6):401–9.

    Article  PubMed  Google Scholar 

  54. Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia. 2013;17(4):445–55.

    Article  CAS  PubMed  Google Scholar 

  55. Timmermans L, Eker HH, Steyerberg EW, Jairam A, de Jong D, Pierik EG, et al. Short-term results of a randomized controlled trial comparing primary suture with primary glued mesh augmentation to prevent incisional hernia. Ann Surg. 2015;261(2):276–81.

    Article  PubMed  Google Scholar 

  56. Caro-Tarrago A, Olona Casas C, Jimenez Salido A, Duque Guilera E, Moreno Fernandez F, Vicente GV. Prevention of incisional hernia in midline laparotomy with an onlay mesh: a randomized clinical trial. World J Surg. 2014;38(9):2223–30.

    Article  CAS  PubMed  Google Scholar 

  57. Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, et al. Prevention of incisional hernias by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment: a randomized controlled trial. Ann Surg. 2016;263(4):638–45.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Erasmus University Medical Center, Room Ee-173, 2040, Rotterdam, Zuid Holland, 3000 AC, The Netherlands

    Leonard Frederik Kroese M.D. & Johan Frederik Lange M.D. Ph.D.

  2. Department of Surgery, Havenziekenhuis Rotterdam, 70031, Rotterdam, Zuid Holland, 3000 LN, The Netherlands

    Johan Frederik Lange M.D. Ph.D.

  3. Department of Neuroscience, Erasmus University Medical Center Rotterdam, Room Ee-1459, Rotterdam, Zuid Holland, 3000 AC, The Netherlands

    Johannes Jeekel M.D. Ph.D.

Authors
  1. Leonard Frederik Kroese M.D.
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  2. Johan Frederik Lange M.D. Ph.D.
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  3. Johannes Jeekel M.D. Ph.D.
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Correspondence to Leonard Frederik Kroese M.D. .

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Editors and Affiliations

  1. Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA

    William W. Hope

  2. USC School of Medicine-Greenville, Greenville Health System, Greenville, North Carolina, USA

    William S. Cobb

  3. Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Gina L. Adrales

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Kroese, L.F., Lange, J.F., Jeekel, J. (2017). Hernia Prevention and the Importance of Laparotomy Closure. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_25

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  • DOI: https://doi.org/10.1007/978-3-319-43045-4_25

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