Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Eva B. Deerenberg*, Nadia A. Henriksen, George A. Antoniou, Stavros A. Antoniou, Wichor M. Bramer, John P. Fischer, Rene H. Fortelny, Hakan Gok, Hobart W. Harris, William Hope, Charlotte M. Horne, Thomas K. Jensen, Ferdinand Koeckerling, Alexander Kretschmer, Manuel Lopez-Cano, Flavio Malcher, Jenny M. Shao, Juliette C. Slieker, Gijs H. J. de Smet, Cesare StabiliniJared Torkington, Filip E. Muysoms

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia.

METHODS: A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative.

RESULTS: Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised.

CONCLUSION: These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.

Original languageEnglish
Pages (from-to)1239-1250
Number of pages12
JournalBritish Journal of Surgery
Volume109
Issue number12
Early online date26 Aug 2022
DOIs
Publication statusPublished - Dec 2022

Bibliographical note

Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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