O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL

Aim The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®). Material and Methods Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy. Results 425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142). Conclusions Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.

Incisional Hernia in Renal Transplant Recipients: A Systematic Review

Incisional hernia follows midline laparotomy in 8 to 20 per cent of cases, but the rate following lateral incision is not well documented. This systematic review summarizes incisional hernia rate after open renal transplant. We searched EMBASE, MEDLINE, and the Cochrane Library databases from January 2000 to November 2016 inclusive. The outcomes included in our analysis were the posttransplant incisional hernia rate, significant patient risk factors for incisional hernia, the definition of incisional hernia used, the method used to detect incisional hernia, and the incision used for transplantation. Eight retrospective case series were identified, three describing renal transplant recipients and five describing incisional hernia repairs postrenal transplant. All reported the incisional hernia rate postrenal transplant at the host institution. The hernia rate ranged from 1.1 to 7.0 per cent, with a mean of 3.2 per cent. Factors associated with incisional hernia were body mass index >30, age >50, cadaveric graft, and reoperation through the same incision. Despite the significant comorbidity of renal transplant recipients, the incisional hernia rate postrenal transplant is significantly lower than that of post-midline laparotomy. The reasons for this are discussed. This demonstrates the importance of operative technique, local tissue quality and biomechanical factors in the formation of incisional hernia.

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction

Introduction Incisional hernia is a common complication of laparoscopic colorectal surgery. Extraction site may influence the rate of incisional hernias. Major risk factors for the development of incisional hernias include age, diabetes, obesity and smoking status. In this study, we investigated the effect of specimen extraction site on incisional hernia rate. Methods Two cohorts of patients who underwent laparoscopic colorectal resections in a single centre in 2005 (n=85) and 2009 (n=139) were studied retrospectively. In 2005 all specimens were extracted through transverse muscle cutting incisions. In 2009 all specimens were extracted through midline incisions. Demographic variables, rate of incisional hernias and risk factors for hernia development were compared between the year groups. All patients had been followed up clinically for two years. Results A total of 224 patients (mean age: 67.5 years, standard deviation: 16.35 years) were included in this study. Of these, 85 patients were in the 2005 transverse group and 139 were in the 2009 midline group. The total incisional hernia rate for the series was 8.0% at the two-year follow-up visit. For the 2005 group, the incisional hernia rate was 15.3% (n=13) and for the 2009 group, it was 3.6% (n=5) (p<0.01). The body mass index was higher in patients who developed incisional hernias than in those who did not (p=0.02). Conclusions The 2005 group had a significantly higher incisional hernia rate than the 2009 group. This is due to the differences in the incision technique and extraction site between the two groups.