Wound Closure and Other Hernia Prevention Strategies

Incisional hernia is a frequent complication of laparotomy. The rate of incisional hernias can be decreased by using an evidence-based small bites suture technique. With this technique, the aponeurosis is sutured continuously with a slow absorbable suture, taking small bites of fascia (5-9 mm) and small stitches (5 mm apart), using 4 times as much suture material as the wound length. Fascial dehiscence is a serious emergent complication of a laparotomy. Closure of the fascia with a mass-closure technique using 10 times as much suture as the wound length should be attempted immediately after diagnosis. If the fascia can’t be closed without tension, use of a traction mesh and vacuum-assisted closure (VAC) is recommended. The use of prophylactic mesh augmentation decreases the rate of incisional hernias, but further studies are needed to clarify patients who will benefit from this.