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The Voodoo that We Do: Controversies in General Surgery.

Yang Lu¹, Ian T Macqueen², David C Chen²

¹Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 72-227 CHS, Los Angeles, CA 90095, USA.

The Surgical Clinics of North America

|November 14, 2021

Summary

Standardized surgical wound closure, like the small bites suture technique, can reduce incisional hernia rates after abdominal surgery. However, evidence is lacking for routine use of abdominal binders or negative-pressure wound therapy.

Keywords:

Abdominal binder Incisional hernia Laparotomy Prophylatic mesh Prophylaxis Small bite Wound closure Wound complications

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Area of Science:

Surgical techniques and patient outcomes
Abdominal surgery complications

Background:

Incisional hernia is a frequent complication after abdominal surgery.
Standardized wound closure methods can decrease hernia incidence.

Purpose of the Study:

To evaluate evidence supporting specific surgical wound closure techniques for reducing incisional hernia.
To identify practices lacking robust data for routine use.

Main Methods:

Review of evidence for fascial closure techniques in abdominal surgery.
Assessment of data supporting practices like abdominal binders, negative-pressure wound therapy, and subcutaneous tissue reapproximation.

Main Results:

Strong evidence supports the small bites, 4-to-1, continuous slow absorbable suture technique for elective midline laparotomies.
Limited or no quality data exist for the routine use of abdominal binders, negative-pressure wound therapy, and subcutaneous tissue reapproximation.

Conclusions:

The small bites suture technique is recommended for reducing incisional hernias in elective midline laparotomies.
Routine use of abdominal binders, negative-pressure wound therapy, and subcutaneous tissue reapproximation lacks sufficient evidence and requires further investigation.