scholarly journals Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Patrick Heger ◽  
Manuel Feißt ◽  
Johannes Krisam ◽  
Christina Klose ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Randomized Controlled ◽  
Onlay Technique ◽  
Mesh Augmentation ◽  
Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques incisional hernia rates are reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia rates, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination.Methods The HULC trial is a multicentre randomized controlled, observer and patient blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in onlay technique. The primary endpoint will be the occurrence of incisional hernias as defined by the European Hernia Society within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes.Discussion The HULC trial will address the yet unanswered question whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the rate of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

scholarly journals Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial): study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Patrick Heger ◽  
Manuel Feißt ◽  
Johannes Krisam ◽  
Christina Klose ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Randomized Controlled ◽  
Onlay Technique ◽  
Mesh Augmentation ◽  
Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. Trial registration German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.

scholarly journals Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Patrick Heger ◽  
Manuel Feißt ◽  
Johannes Krisam ◽  
Christina Klose ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Closure ◽  
Incisional Hernias ◽  
Randomized Controlled ◽  
Combination Methods ◽  
Onlay Technique ◽  
Mesh Augmentation ◽  
Patient Reported

Abstract Background: Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques the risk for developing an incisional hernia is reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods: The HULC trial is a multicentre randomized controlled, observer and patient blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in onlay technique. The primary endpoint will be the occurrence of incisional hernias as defined by the European Hernia Society within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion: The HULC trial will address the yet unanswered question whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

scholarly journals A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

2017 ◽  
Vol 4 (7) ◽  
pp. 2291
Author(s):  
Rajasekaran C. ◽  
Vijaykumar K. ◽  
Arulkumaran M. ◽  
Meera S. S.
Keyword(s):  
Randomized Controlled Trial ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Abdominal Closure ◽  
Randomized Controlled ◽  
Abdominal Repair

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

scholarly journals Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

2017 ◽  
Vol 4 (8) ◽  
pp. 2534
Author(s):  
Nicolo Tamini ◽  
Marco Cereda ◽  
Giulia Capelli ◽  
Alessandro Giani ◽  
Luca Gianotti
Keyword(s):  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Abdominal Wall ◽  
Data Retrieval ◽  
Fascial Closure ◽  
Skin Closure ◽  
Absorbable Suture ◽  
Site Infection ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy

Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

scholarly journals Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial

2021 ◽  
Author(s):  
S. Honig ◽  
H. Diener ◽  
T. Kölbel ◽  
W. Reinpold ◽  
A. Zapf ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Controlled Trial ◽  
Fascial Closure ◽  
Absorbable Suture ◽  
Double Blind ◽  
Midline Laparotomy ◽  
Mesh Augmentation ◽  
Onlay Mesh ◽  
Randomised Controlled

AbstractThe reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.

scholarly journals Technique of Midline Abdominal Incision Closure Among Surgical Trainees

2020 ◽  
Vol 17 (2) ◽  
pp. 72-75
Author(s):  
Alex Muturi ◽  
Kotecha Vihar ◽  
Pulei Ann ◽  
Maseghe Philip
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Tertiary Hospital ◽  
Fascial Closure ◽  
Wound Complications ◽  
Absorbable Suture ◽  
Abdominal Wall Closure ◽  
Abdominal Incision ◽  
Abdominal Closure ◽  
Surgical Trainees

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used. Methods: A descriptive study was carried out from October 2015 to May 2016. Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds. Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital. Keywords: Abdominal closure, Midline incision, Wound complications

scholarly journals Evaluation of a new technique for abdominal wall closure in midline laparotomies

2018 ◽  
Vol 5 (8) ◽  
pp. 2701
Author(s):  
Moharam Abdelsamie Mohamed Abd El Shahid ◽  
Fawzy Abo Bakre Mahmoud ◽  
Said Ebrahim Elmallah
Keyword(s):  
Abdominal Wall ◽  
Wound Dehiscence ◽  
New Technique ◽  
Abdominal Wall Closure ◽  
University Hospitals ◽  
Midline Laparotomy ◽  
Randomized Clinical Study ◽  
A New Technique ◽  
One Year ◽  
Critical Aspects

Background: An efficient technique for abdominal wall closure should provide strength and be a barrier against infection. Method of closure and type of suture material are critical aspects of an effective abdominal wall closure after midline laparotomy. Dehiscence of abdominal wounds after closure is a serious complication especially in emergency laparotomies. Our study was done to know whether our method of abdominal closure was helpful in reducing incidence of wound dehiscence.Methods: Present study was carried out as a retrospective randomized clinical study in the department of general surgery, Menoufia University Hospitals for one year starting from March 2017 to March 2018. 168 patients had midline laparotomies (either elective or emergent) for inflammatory, traumatic or neoplastic indications.Results: In present study for this new technique of abdominal wall closure after midline laparotomies, wound infection was noticed in 12/168 (7.2%) cases and 2/168 (1.2%) patients developed wound dehiscence.Conclusions: Present study demonstrates that our new technique (Moharam Repair) of abdominal wall closure after midline laparotomies) is efficient in reducing post-operative wound dehiscence (burst abdomen). So, this technique is applicable, safe, and can minimize morbidities and mortalities related to wound dehiscence (as a short-term complication) after midline exploratory laparotomies (MEL).

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