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An incisional hernia is a frequent complication after primary elective midline laparotomy, with an incidence of 5–20%, which increases to 40% in specific risk groups.1 2 It is associated with high morbidity, decreased quality of life, and high costs.1 2 Additionally, repair of incisional hernias has a high failure rate, leading to long term recurrence rates >30%.1 Therefore, prevention of incisional hernias is important.
Major patient related factors include obesity, increasing age, multiple surgeries, and abdominal aortic aneurysm.1 Technical factors include insecure knots, inadequate suture bites of fascia, excessive distance between fascial sutures, and excessive tension on the closure.3
The materials and surgical technique used to close an abdominal wall incision are crucial determinants of the risk of developing an incisional hernia.2 3 Optimizing the surgical technique by using evidence based principles has the potential to prevent incisional hernias and the sequelae of repairs.1 3 Currently, the use of single layer aponeurotic closure with slowly absorbed monofilament sutures using a running, small bites technique with a ≥4:1 suture to wound length ratio, is strongly recommended for closure of elective midline incisions of the abdominal wall.1–3
This video (Video 1) presents the basic principles of closure of abdominal midline wall incisions in gynecological oncology (Figure 1). It also shows how the main anatomical structures of the abdominal wall are the key aspects of the small bites technique. The procedure describes seven steps to achieve successful closure of the abdominal wall after oncological surgery.
Single layer aponeurotic closure with slowly absorbed monofilament suture using a running, small bites technique.
Data availability statement
There are no data in this work.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants but Research Institute (i+12). Hospital Universitario 12 de Octubre, Madrid, Spain. Case report with consent obtained from the patient. Exempted this study. Participants gave informed consent to participate in the study before taking part.
Footnotes
Contributors Video article conception, design, and edition: MRO-P and BCN. Draft manuscript preparation: MRO-P, BCN, RB, and BG-I. Supervision: OC-M and AT-G. The illustrations represented in the video were made by a private company. MRO-P is responsible for the overall content as guarantor. All authors have viewed and approved the final version of the video and have read and approved the final version of the manuscript to be published and are agreeing to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.