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Small bite fascial closure technique reduces incisional hernia rates in gynecologic oncology patients
Alli M Straubhar1, Cynthia Stroup1, Amanda Manorot1
1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
Background:
The potential for the technique of small bite fascial closure in mitigating incisional hernias in gynecologic oncology patients still needs to be investigated.
Objective:
To evaluate the impact of closure of small fascial bites compared with prior standard closure on incisional hernia rates in gynecologic oncology patients.
Methods:
This is a retrospective cohort study comparing patient outcomes before and after the intervention at a single institution at a comprehensive cancer center. Patients who underwent laparotomy with a vertical midline incision for a suspected or known gynecologic malignancy with a 1-year follow-up were included. The pre-intervention cohort (large bites) had 'mass' or modified running Smead-Jones closure. In contrast, the post-intervention cohort had fascial bites taken 5-8 mm laterally with no more than 5 mm travel (small bites) closure using a 2-0 polydioxanone suture.The primary outcome was the incisional hernias rate determined by imaging or clinical examination within the first year of follow-up. Patient factors and peri-operative variates of interest were investigated for their association with hernia formation through univariate and multivariate analyses. These included age, body mass index (BMI), smoking history, estimated blood loss, pre-operative albumin, American Society of Anesthesia (ASA) physical status classification, or treatment with chemotherapy post-operatively.
Results:
Of the 255 patients included, the total hernia rate was 12.5% (32/255 patients). Patient characteristics were similar in both cohorts. Small bite closure led to a significant reduction in hernia rates from 17.2% (22/128 patients) to 7.9% (10/127 patients), p=0.025. According to logistic regression modeling, small bite closure (OR=0.40, 95% CI 0.17 to 0.94, p=0.036) was independently associated with lower odds of hernia formation. Other factors associated with increased hernia rates were chemotherapy (OR=3.22, 95% CI 1.22 to 8.51, p=0.019) and obesity (OR=23.4, 95% CI 3.09 to 177, p=0.002). In obese patients, small bite closures led to maximal hernia rate reduction compared with large bites.
Conclusions:
The small bite closure technique effectively reduces hernia rates in gynecologic oncology patients undergoing midline laparotomy.
Insights
The small bite fascial closure technique significantly reduces incisional hernia rates in gynecologic oncology patients undergoing midline laparotomy. This method offers a safer approach for preventing hernias in this patient population.
Area of Science:
- Surgical oncology
- Abdominal wall reconstruction
- Minimally invasive surgical techniques
Background:
- Incisional hernias are a significant complication following abdominal surgery, particularly in gynecologic oncology.
- The efficacy of small bite fascial closure in preventing these hernias remains under investigation.
Purpose of the Study:
- To compare the incidence of incisional hernias using small bite fascial closure versus standard large bite closure in gynecologic oncology patients.
- To identify patient-specific factors associated with incisional hernia development.
Main Methods:
- Retrospective cohort study at a comprehensive cancer center.
- Compared outcomes of patients undergoing midline laparotomy before and after implementation of small bite fascial closure (5-8mm bites).
- One-year follow-up for hernia detection via imaging or clinical examination; analyzed patient factors including BMI, smoking, and chemotherapy use.
Main Results:
- Overall hernia rate was 12.5%. Small bite closure significantly reduced hernia rates from 17.2% to 7.9% (p=0.025).
- Small bite closure was independently associated with lower odds of hernia formation (OR=0.40, p=0.036).
- Chemotherapy (OR=3.22) and obesity (OR=23.4) were associated with increased hernia rates; small bite closure showed maximal benefit in obese patients.
Conclusions:
- Small bite fascial closure is an effective technique for reducing incisional hernia rates in gynecologic oncology patients.
- This technique represents a valuable advancement in surgical closure to improve patient outcomes and prevent complications.
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