Article Text

Download PDFPDF

Step by step abdominal wall closure in elective midline laparotomy
Free
  1. M Reyes Oliver- Perez1,2,
  2. Oscar Caso-Maestro2,3,
  3. Beatrice Conti-Nuño4,
  4. Rocio Bermejo4,
  5. Blanca Gil-Ibañez1 and
  6. Alvaro Tejerizo-Garcia1,2
    1. 1Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
    2. 2Universidad Complutense, Madrid, Spain
    3. 3Department of Surgery, Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain
    4. 4Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid, Spain
    1. Correspondence to Dr M Reyes Oliver- Perez, Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid 28041, Spain; m.delosreyes.oliver{at}salud.madrid.org

    Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    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.

    Video 1 Abdominal wall closure in elective midline laparotomy.
    Figure 1

    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.

    References

    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.