Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Comparative Study
[Current standards of abdominal wall closure techniques : Conventional suture techniques].
The most frequent complications following midline abdominal laparotomy include incisional hernias, which develop in 10-15 % of patients and surgical site infections in 15-25 % of cases; however, the risk of these complications can be reduced by the surgical technique and the use of special suture materials. In 2010, the INLINE meta-analysis performed by the Study Centre of the German Society of Surgery (SDGC) revealed that a continuous suture technique using slowly absorbable suture material resulted in the lowest risk of developing postoperative incisional hernia after elective midline laparotomy. ⋯ Current evidence shows that slowly absorbable monofilament suture material using a continuous suture technique provides the best results with regard to incisional hernia rates after elective midline laparotomy. Triclosan-coated sutures cannot be recommended as a standard suture material as they failed to reduce surgical site infections. For emergency laparotomies no evidence exists to recommend a specific kind of suture technique or a special suture material.
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There is a high incidence of incisional hernias in specific high-risk patient populations. For these patients, the prophylactic placement of mesh during closure of the abdominal wall incision has been investigated in several prospective studies. ⋯ Prophylactic mesh implantation should be the standard of care during construction of an elective end colostomy and will become the standard of care for midline laparotomies in patients at high risk of incisional hernias.