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Study, year
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Inclusion and exclusion criteria
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Description of the modification of closure technique and used closure in the control group
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Outcome measurements
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Diagnosis of IH (Clinical/Radiological)
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Follow-up (months)
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Niggebrugge 1999
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Older than 15 years undergoing an elective or emergency surgery.
Excluded: patients who had a laparotomy in the previous 3 months.
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The CDLC technique consists of a running suture that forms outer and inner loops in one plane. Stress on the outer loop produces tension in the inner loop that a p p r o x i m a t e s the wound edges. It passes through all layers of the abdominal wall at 2 cm from the wound edges, and again through anterior fascia, muscle, and posterior fascia at 1 cm from the wound edges. Adjacent loops were close together in the two groups (1 cm). Closure of the peritoneum was not a d v o c a t e d (Figure 4).
The closure in the control group: technique was a continuous mass-closure technique that encompasses all layers of the abdominal wall apart from the skin. The margins between suture and wound edge were at least 1 cm.
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IH, Wound Infection, Pain, haematoma, wound dehiscence, Ileus and Relaparotomy.
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Clinical
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1
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Marwah 2005
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Generalized peritonitis who underwent emergency laparotomy through midline incisions.
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A longitudinal incision was then made through each anterior rectus sheath about 6 to 7 cm lateral to the incision line, which relaxed the rectus sheath flap and exposed the anterior surface of the rectus muscle. The fascial edges of the linea alba were thereafter sutured in the midline with continuous nonabsorbable polypropylene (Figure 4).
Control group: the laparotomy wound closure consisted of a single layer of continuous suturing of fascial edges of the linea alba with nonabsorbable polypropylene in the midline. The skin and subcutaneous tissue were approximated with interrupted nonabsorbable sutures.
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IH, Wound dehiscence, Wound Infection, Pain, and Ileus.
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Clinical
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6
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Millbourn 2009
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Patients older than 18 years who underwent emergent or planned surgery.
Excluded: Patients with a previous midline incision, a previous abdominal incision crossing the midline, or a preexisting ventral hernia such as an umbilical or epigastric.
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The short stitch group, surgeons were urged to place stitches 5 to 8 mm from the wound edge and to include only the aponeurosis in the stitches. In this group, 2-0 polydioxanone suture on a needle with a half-circle, tapered point and a diameter of 20 mm was used (PDS II suture and MH-1 needle: Ethicon GmbH) (Figure 4).
The long stitch length, the previous standard technique for wound closure at the department was used and stitches were placed at least 10 mm from the wound edge. For the long stitch group, a 1-0 polydioxanone suture on a needle with a half-circle, tapered point and a diameter of 41 mm was used (PDS II suture and TP-1 needle; Ethicon GmbH).
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IH, Wound dehiscence, Wound Infection.
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Clinical
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12
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Agarwal 2011
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Patients older than 18 years who underwent emergent surgery.
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RTL (reinforced tensión line). The rectus sheath is cleared about 1.5 cm laterally linea alba. The longitudinal suture (polydioxanone) is inserted using a 65-mm 1/2 needle parallel to the linea alba, starting at the lower end of the incision, as a continuous suture on both sides, after first clearing the fat about 2 cm from it. The ends are held by haemostats inferiorly. Then the continuous suture (again polydioxanone) is placed using again a 65-mm 1/2 needle, taking care that the points are introduced laterally to the longitudinal suture. This suture is tied and knotted, the subcutaneous sutures and skin sutures are used to close the wound (Figure 4).
Control group: A simple suture loop polydioxanone (PDS) was used as suture material and a 65-mm 1/2 needle was used in all patients who underwent abdominal closure by simple closure.
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Wound dehiscence
Intra-abdominal pressure
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Clinical
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1
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Khorgami 2013
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Inclusion criteria: 10-cm surgical incision minimum, and having 2 of the following preoperative risks factors: poor nutritional status (clinical cachexia or hypoalbuminemia); emergent surgery; intra-abdominal infection; uncured extensive-stage malignancy; use of corticosteroids in the last 12 mo (>10 mg/d prednisolone or equivalent for ≥3 mo); uremia; hemodynamic instability (BP ≤ 90 mm Hg); hemoglobin 3 mg/dL); diabetes mellitus; and age >60 y. Patients younger than 18 y and those with an incision length of < 10 cm were excluded.
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Retention sutures were added using a #1 nylon string every 10 cm and contained 5 cm of the skin, subcutaneous tissue, rectus muscle, and abdominal fascia (except peritoneum) on each side. The first retention suture was placed 5 cm above the lower end of the incision and repeated every 10 cm toward the upper part of the incision (Figure 4).
Control group: the fascia was sutured continuously using a running looped #1 nylon string located 1 cm from the edge of the linea alba with 1-cm intervals. The running suture was locked intermittently every 5 cm to divide the long continuous suture into multiple smaller sections. Subcutaneous tissue was not sutured, and skin was closed using interrupted suture of 3-0 nylon.
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IH, Wound Infection, Pain, haematoma, wound dehiscence, Ileus and Relaparotomy.
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Clinical
Ultrasonography
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3-15
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Deerenberg 2015
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Patients aged 18 years or older, elective abdominal surgery. Excluded patients with a history of incisional hernia or fascial dehiscence after midline laparotomy, those who had undergone abdominal surgery through a midline incision within the past 3 months, those who were pregnant, or those who had participated in another intervention trial.
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The suture technique was applied with tissue bites of 5 mm and intersuture spacing of 5 mm. In all cases the stitch incorporated the aponeurosis only and incorporation of fat or muscle tissue was avoided (Figure 4).
Group control: The conventional large tissue bites or mass closure technique was applied with tissue bites of at least 1 cm and intersuture spacing of 1 cm with USP 1 double loop PDS Plus II (Ethicon) with a 48 mm needle.
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IH, Wound Infection, Pain, haematoma, wound dehiscence, Ileus and Relaparotomy, cardiac events, length of hospital stay, and health-related quality of life
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Clinical
Ultrasonography
CT abdominal
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12
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|
Dhamnaskar 2016
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Emergency midline laparotomy, age group of 18 to 70 years were included whose surgeries could be classified as contaminated or infected/dirty.
Presence or suspicion of the abdominal compartment syndrome was excluded. Patients having previous midline laparotomy scars were excluded. Children and pregnant women were also excluded.
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Smead-Jones closure technique of far-near and near-far suturing was interrupted. But we proposed continuous far-near and near-far suturing technique as modified Smead-Jones technique, which was used for midline fascial closure in the study group. In this technique suturing was done with points ‘A’ and ‘D’ being 1.5 cm away from the edge of the fascia and points ‘B’ and ‘C’ being 0.5 cm away from the fascial edge. The distance between two successive continuous sutures was not more than 1 cm. There was one 2 x 1 x 1 x 1 surgical knot at each end of laparotomy wound (Figure 4).
In the controlled arm, midline closure was done with interrupted sutures 1.5 cm away from the cut margin/edge of fascia tied every time with 2 x 1 x 1 x 1 surgical square knots. Again, distance between two consecutive sutures was not more than 1 cm.
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Wound dehiscence and wound infection
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Clinical
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1
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Peponis 2018
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Adult patients undergoing midline laparotomy for gastrointestinal emergencies were considered eligible for inclusion. Excluded patients who underwent elective operations, laparotomies due to trauma, were pregnant, did not have their fascia closed, were not expected to survive for more than 2 days given their baseline comorbid status, had a primary ventral hernia with or without mesh in place, had undergone any abdominal operation within the last 30 days, or were unable to communicate in English.
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Interrupted closure was also performed with no. 0 nonlooped, slowly absorbable polydioxanone, sutures in a simple interrupted fashion. Again, sutures were placed at 10 mm from the fascial edge after advancing 10 mm (Figure 4).
Patients in the continuous group had their fascia closed with no. 0 nonlooped, slowly absorbable polydioxanone sutures (Ethicon, Inc, Somerville, NJ). The ratio of suture length to incision length was kept at 4:1. A tapered needle was used, and the fascia was closed from both the superior and inferior edge of the wound simultaneously, with the sutures being placed at approximately 10 mm from the fascial edge and 10 mm advancement. The fascia was eventually closed in the middle of the incision, where the two sutures were knotted together with at least four-square knots or eight throws.
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IH, Wound Infection, wound dehiscence, and mortality.
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Clinical
Ultrasonography
CT Abdominal
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24
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|
Lozada 2021
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Patients older than 18 years, emergency or scheduled, regardless of their underlying diagnosis, who were considered high risk, and who completed 3-year follow-up were included. All patients with a score of≥6 on the Rotterdam risk model were defined as high risk. Excluded were pregnant women, those who underwent any other protocol of wall closure, those for whom it was decided to manage the open abdomen at the end of the surgery, those with incomplete data who could not be classified on the Rotterdam scale, those who had a history of previous midline laparotomy, those who did not attend their postoperative check-ups, and patients reoperated through the same wound for a situation different from the IH and therefore did not complete the 3-year follow-up.
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Two longitudinal and parallel suture lines were placed, each along the fascial aponeurotic edge. Suturing was started with a PDS Plus II suture number 1 needle of 48 mm in length at one end of the wound where the stitch ran longitudinally and parallel to the aponeurotic edge. The needle entered and exited at intervals of 1 cm and was kept 0.5–0.8 cm from the edge of the aponeurosis. Upon reaching the opposite angle of the wound, another suture with the same characteristics was used, repeating the process on the opposite aponeurotic edge. The ends of the two sutures were knotted at the angles. In this way, the aponeurotic wound was left with two suture lines reinforcing its edges. The wound was closed as indicated in the control group, always taking care that the stitch included and anchored the two longitudinal strands of reinforcement. The rest of the wound was closed in a conventional manner. No drains were left in the wound (figure 4).
Control group: At the end of the surgical procedure, the abdominal wall was closed in masse with PDS Plus II monoflament number 1 (Ethicon) with a 48 mm needle, starting the suture of one of the ends of the wound. It was continued with a simple continuous stitch, advancing each point 1 cm away from the other and one centimeter away from the edge of the aponeurosis, in the midpoint of the wound, with knotting, following the Jenkins 4:1 rule. At the opposite end of the wound, the closure was started in the same way, and the closure of the aponeurosis was continued until it was more than 1 cm away from the previous stitch. The stitches were knotted separately, and the rest of the wound was closed in a conventional manner. There were no drains left.
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IH, Wound Infection, Pain, haematoma, wound dehiscence, and seroma.
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Clinical
CT abdominal
|
36
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