Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 2/2021

01-04-2021 | Incision | Original Article

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

Authors: C. B. Paulsen, D. Zetner, J. Rosenberg

Published in: Hernia | Issue 2/2021

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Alkatout I, Mettler L (2017) Hysterectomy a comprehensive surgical approach. J Turk Ger Gynecol Assoc 18:221–223CrossRef
2.
3.
4.
Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V (2004) The Pfannenstiel or so called "bikini cut": still effective more than 100 years after first description. Hernia 8:177–181CrossRef
5.
Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24CrossRef
6.
Williams Z, Williams S, Easley HA, Seita HM, Hope WW (2017) An evaluation of abdominal wall closure in general surgical and gynecological residents. Hernia 21:873–877CrossRef
7.
Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP (2013) Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 209:294–306CrossRef
8.
Anderson ER, Gates S (2004) Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database Syst Rev CD004663
9.
de Graaf IM, Oude Rengerink K, Wiersma IC, Donker ME, Mol BW, Pajkrt E (2012) Techniques for wound closure at caesarean section: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 165:47–52CrossRef
10.
Husslein H, Gutschi M, Leipold H, Herbst C, Franz M, Worda C (2014) Suture closure versus non-closure of subcutaneous fat and cosmetic outcome after cesarean section: a randomized controlled trial. PLoS ONE 9:e114730CrossRef
11.
Chelmow D, Rodriguez EJ, Sabatini MM (2004) Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol 103:974–980CrossRef
12.
Bamigboye AA, Hofmeyr GJ (2014) Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database Syst Rev CD000163
13.
Gurusamy KS, Cassar Delia E, Davidson BR (2013) Peritoneal closure versus no peritoneal closure for patients undergoing non-obstetric abdominal operations. Cochrane Database Syst Rev CD010424
14.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRef
15.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRef
16.
Joel-Cohen S (1977) Abdominal and vaginal hysterectomy. Heinemann, Portsmouth
17.
Israelsson LA, Millbourn D (2013) Prevention of incisional hernias: how to close a midline incision. Surg Clin N Am 93:1027–1040CrossRef
18.
Israelsson LA (1999) Bias in clinical trials: the importance of suture technique. Eur J Surg 165:3–7CrossRef
19.
Israelsson LA, Millbourn D (2012) Closing midline abdominal incisions. Langenbecks Arch Surg 397:1201–1207CrossRef
20.
Sanders DL, Kingsnorth AN (2012) The modern management of incisional hernias. BMJ 344:e2843CrossRef
21.
Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW et al (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390:567–576CrossRef
22.
van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150CrossRef
23.
Grimshaw J, Eccles M, Tetroe J (2014) Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof 24:S31–S37CrossRef
24.
Gurusamy KS, Toon CD, Davidson BR (2014) Subcutaneous closure versus no subcutaneous closure after non-caesarean surgical procedures. Cochrane Database Syst Rev CD010425
25.
26.
Bloemen A, De Kleijn R, Van Steensel S, Aarts F, Schreinemacher MHF, Bouvy ND (2019) Laparotomy closure techniques: do surgeons follow the latest guidelines? Results of a questionnaire. Int J Surg 71:110–116CrossRef
27.
Livingston EH, Wislar JS (2012) Minimum response rates for survey research. Arch Surg 147:110CrossRef
28.
Aerny-Perreten N, Dominguez-Berjon MF, Esteban-Vasallo MD, Garcia-Riolobos C (2015) Participation and factors associated with late or non-response to an online survey in primary care. J Eval Clin Pract 21:688–693CrossRef
29.
Groves RM, Peytcheva E (2008) The impact of nonresponse rates on nonresponse bias: a meta-analysis. Public Opin Q 71:167–189CrossRef
30.
Edwards PJ, Roberts I, Clarke MJ, Diguiseppi C, Wentz R, Kwan I et al (2009) Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev MR000008
Metadata
Title
Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties
Authors
C. B. Paulsen
D. Zetner
J. Rosenberg
Publication date
01-04-2021
Publisher
Springer Paris
Published in
Hernia / Issue 2/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-020-02280-w

Other articles of this Issue 2/2021

Hernia 2/2021 Go to the issue

Original Article

Robotic ventral hernia repair: a safe and durable approach

Original Article

A multistage process leading to the development of a structured consent form and patient information leaflet for complex abdominal wall reconstruction (CAWR)

Original Article

Does perfusion matter? Preoperative prediction of incisional hernia development

How-I-Do-It

Signs and landmarks in eTEP Rives-Stoppa repair of ventral hernias

Original Article

Is concomitant cholecystectomy safe during abdominal wall reconstruction? An AHSQC analysis

Original Article

Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications