Cyclic pulse loads generate the new concept in abdominal wall reconstruction: suture closure

Abstract

Aim: Incisional hernias frequently occur after open abdominal surgery. Up to 30% of elective midline laparotomy closures result in an incisional hernia. The properties of a safe abdominal wall reconstruction must be assessed under lifelike conditions to obtain a realistic estimate of the durability. The interplay of the biomechanical qualities determines the long-term stability of a repair. Various suture materials and techniques for optimal closure of the abdominal wall are still under discussion. The results of this experimental study might significantly affect the active discussion about optimal suturing techniques for median abdominal wall closure.

Methods: For this purpose, a bench test was developed that delivers repetitive cyclic pressure impacts to the abdominal wall, simulating coughs. This allows the assessment of the reconstructed abdominal wall as a compound. We used stiff porcine abdominal walls and elastic bovine flanks as model tissues. We chose two different types of defects. Type one consisted of a 15 cm long medial incision, whereas for type two, a 5 cm circular defect was added in the center of the incision. The incisions were solely sutured in large-bite (0.8-1.2 mm bites) or small-bite (0.5-0.8 mm bites) technique with Monomax^® or PDS^® sutures USP 2-0 or USP 1. The suture to wound length (SWL) ratio had to exceed 4:1. After suturing, the tissues were subjected to repetitive cyclic loading on a validated bench test.

Results: We found that regardless of technique and material thickness, secure closure of median abdominal wall incisions is feasible by suturing. In larger defects, the small bites technique using Monomax^® sutures achieves a safer closure compared to PDS^® sutures.

Conclusion: Based on the results of this experimental study, a tailored standardized closure technique after midline incision of the abdominal wall, including an optional mesh augmentation, is recommended.

Keywords

Incisional hernia / suture technique / abdominal wall reconstruction / biomechanical repair / multiaxial tissue assessment

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