[Laparotomy closure - do we know how?(Guideline of the European Hernia Society)]

The recurrence rate of surgical treatment of incisional hernia is high. The material and surgical technique used to close the abdominal wall following every surgery contribute as important risk factors in incisional hernia formation. However, by optimising abdominal wall closure, many patients can be spared from developing this type of complication. The European Hernia Society has established a Guidelines Development Group with a goal to research the literature and write a series of recommendations of how to close the abdomen and minimize the risk of incisional hernia in accordance with the principles of evidence-based medicine. To decrease the incidence of incisional hernias, the following is recommended: To utilise a non-midline approach to a laparotomy whenever possible. To perform a continuous suturing technique using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique. To perform the small bites technique with a suture to wound length (SL/WL) ratio at least 4/1. Not to close the peritoneum separately. To avoid rapidly resorbable materials. To consider using a prophylactic mesh in high-risk patients. To use the smallest trocar size adequate for the procedure and closing the fascial defect if trocars larger or equal to 10 mm are used in laparoscopic surgery. Key words: incisional hernia laparotomy laparotomy closure suturing material.