[Current standards of abdominal wall closure techniques : Conventional suture techniques]

Area of Science:

• Surgical oncology
• Gastrointestinal surgery
• Abdominal surgery

Background:

• Incisional hernias (10-15%) and surgical site infections (15-25%) are common after midline abdominal laparotomy.
• Surgical technique and suture materials can mitigate these risks.
• A 2010 meta-analysis recommended continuous sutures with slowly absorbable material for reduced hernia risk.

Purpose of the Study:

• To update the 2010 INLINE meta-analysis.
• To systematically review randomized controlled trials (RCTs) on abdominal wall closure since 2010.
• To summarize current evidence on surgical techniques and materials for midline laparotomy closure.

Main Methods:

• Systematic literature search in MEDLINE and CENTRAL on January 28, 2016.
• Inclusion of all published RCTs on abdominal wall closure after midline laparotomy since 2010.
• Analysis of 9 identified RCTs comparing different closure techniques and suture materials.

Main Results:

• Three RCTs on suture materials showed no significant difference in incisional hernia rates compared to the 2010 meta-analysis.
• Slowly absorbable sutures with a continuous technique remain recommended for elective midline laparotomy.
• Six RCTs on antimicrobial sutures found no advantage for Triclosan-coated material in reducing surgical site infections.

Conclusions:

• Slowly absorbable monofilament sutures and continuous technique yield the lowest incisional hernia rates in elective midline laparotomy.
• Triclosan-coated sutures are not recommended for routine use due to lack of efficacy in reducing surgical site infections.
• No specific suture technique or material is currently recommended for emergency laparotomies based on available evidence.