Wound closure and postoperative hernia prevention strategies

Closure of the laparotomy wound is the first and most important time point for prevention of postoperative hernia. Abdominal wound dehiscence and incisional hernia are major complications, associated with high morbidity and even mortality. Various risk models have been developed for both conditions, consisting of both patient and surgery-related risk factors. Surgical risk factors that can be influenced by surgeons include type of incision, type of suture material, and type of suture technique. In order to prevent incisional hernia in the midline incision, it is advocated to suture the abdominal wall continuously in a mass closure technique. Slowly absorbable sutures should be used with a suture length to wound length ratio of at least 4:1 using small stitches (5–8 mm) with small inter suture distances (5 mm). Currently, there is not enough evidence to support the use of retention sutures or abdominal binders to prevent incisional hernia. In high-risk patients, e.g., with obesity or abdominal aortic aneurysms, it should be considered to use prophylactic mesh (in onlay or sublay position). Prophylactic mesh in onlay position has been associated with increased incidence of seroma formation.

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