INCISIONAL HERNIA DEVELOPMENT AFTER MASS AND LAYERED CLOSURE OF UPPER ABDOMINAL TRANSVERSE INCISIONS: RESULTS OF A RANDOMIZED CONTROLLED TRIAL mwkrasn@gmail.com

 

INCISIONAL HERNIA DEVELOPMENT AFTER MASS AND LAYERED CLOSURE OF UPPER ABDOMINAL TRANSVERSE INCISIONS: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

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Wojciech Figiel w.figiel@yahoo.es Medical University of Warsaw, Poland Department of General, Transplant, and Liver Surgery, Warsaw Poland

Krzysztof Zieniewicz krzysztof.zieniewicz@wum.edu.pl Medical University of Warsaw, Poland Department of General, Transplant, and Liver Surgery, Warsaw Poland

Marek Krawczyk marek.krawczyk@wum.edu.pl Medical University of Warsaw, Poland Department of General, Transplant, and Liver Surgery, Warsaw Poland

Michal Grat michal.grat@wum.edu.pl Medical University of Warsaw, Poland Department of General, Transplant, and Liver Surgery, Warsaw Poland

Poland

Oral or Poster

Incisional hernias remain a common complication after laparotomies. There is a paucity of high-quality data from prospective randomized trials on the association between the type of abdominal closure technique used for transverse epigastric incisions and the development of incisional hernias.

This prospective randomized controlled trial included 392 patients who underwent laparotomy through a transverse epigastric incision. Patients were randomly assigned to either continuous mass (MC) or layered closure (LC) in a 1:1 ratio. The primary combined endpoint of the study was the occurrence of burst abdomen in the immediate postoperative period or incisional hernia within two years. (ClinicalTrials.gov: NCT03561727).

A total of 71 hernias or burst abdomens occurred - 48 were recorded in MC and 23 in LC arm. Seven patients developed burst abdomen - 3 (1.5%) in MC arm and 4 (2.0%) in LC arm (p > 0.99). At 24 months, the cumulative incidence of hernia or burst abdomen in the MC group was 73.7% (95% confidence interval: 59.3% – 83.0%), compared to 35.0% (95% confidence interval: 20.6% – 46.7%) in the LC group (p = 0.002). Fifty-three patients developed an incisional surgical site infection (I-SSI) – 36 (18.4%) in the MC arm and 17 (8.7%) in the LC arm (p = 0.005).

Layered continuous technique should be the standard for abdominal closure after transverse epigastric laparotomy.