Laparotomy closure techniques: Do surgeons follow the latest guidelines? Results of a questionnaire
Laparotomy closure techniques: Do surgeons follow the latest guidelines? Results of a questionnaire
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DOI：
10.1016/j.ijsu.2019.09.024
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发表时间：
2019-11-01
影响因子：
15.3
通讯作者：
Bouvy, N. D.
中科院分区：
文献类型：
--
作者：
Bloemen, A.;De Kleijn, R. J. C. M. F.;Bouvy, N. D.
目的：剖腹手术后切口疝与显著的发病率和费用增加有关。关于预防切口疝形成的最新研究表明，使用缓慢可吸收单股缝线的剖腹术闭合技术，具有连续单层小筋膜台阶和咬合，缝线长度与伤口长度（SL/WL）比至少为4：1，可有效降低发病率。很少有人知道如何在日常实践中应用这一证据。因此，在荷兰surgics.Methods：荷兰外科学会的所有成员进行了调查，应邀参加了一个24个问题的在线调查技术和材料用于腹壁关闭后中线剖腹手术。亚组分析进行了手术亚专业，类型的医院和experience.Results的基础上：响应率为26%（402名受访者），占97%的所有荷兰外科部门。超过90%的参与者使用可缓慢吸收的单股连续缝合线在单个肿块层中闭合腹壁。仅35%的参与者使用> 4：1的SL/WL比率，并且参与者之间的首选缝线尺寸是可变的。切口疝发生的风险因素通常被正确识别，但超过一半的参与者不知道切口疝的发生率和发生时间。亚组分析发现，胃肠道和肿瘤外科医生偏好较小直径的缝线和较高的缝线长度与伤口长度比。创伤、血管和小儿外科医生对切口疝发生率的估计低于其他专科。与非学术医院的同事相比，学术医院的外科医生更有可能使用小筋膜台阶和较小的缝线尺寸。正确估计切口疝的发病率下降时，外科医生进行不到10 laparotomies annually.Conclusion：实施的最新证据有关的腹壁闭合技术并不普遍。只有35%的外科医生使用4：1的缝线长度与伤口长度比闭合腹部筋膜，这是基于最新证据推荐的。外科实习生、胃肠道和肿瘤外科医生最熟悉推荐的技术，并在日常实践中使用。应努力改进这项技术的推广。
Purpose: Incisional hernias after laparotomy are associated with significant morbidity and increased costs. Recent research on prevention of incisional hernia formation suggests that a laparotomy closure technique using a slowly absorbable monofilament suture with small fascial steps and bites in a continuous, single layer with a suture length to wound length (SL/WL) ratio of at least 4:1 is effective in lowering morbidity. Little is known about application of this evidence in daily practice. Therefore, a survey was performed among Dutch surgeons.Methods: All members of the Dutch Surgical Society were invited to participate in a 24-question online survey on techniques and materials used for abdominal wall closure after midline laparotomy. Subgroup analysis was performed based on surgical subspecialty, type of hospital and experience.Results: Response rate was 26% (402 respondents), representing 97% of all Dutch surgical departments. More than 90% of participants closed the abdominal wall in a single mass layer, using a slowly absorbable monofilament running suture The SL/WL ratio of > 4:1 is practiced by only 35% of participants and preferred suture size was variable among participants. Risk factors for incisional hernia development were generally identified correctly but more than half of the participants were unaware of the incidence and time of occurrence of incisional hernia. Subgroup analysis found that gastrointestinal and oncologic surgeons preferred smaller diameter sutures and higher suture-length to wound-length ratios. Trauma, vascular and pediatric surgeons had lower estimates of incidence of incisional hernia than other subspecialties. Surgeons employed in academic hospitals were more likely to use small fascial steps and smaller suture sizes than their colleagues in non-academic hospitals. Correct estimates of incisional hernia incidence decreased when surgeons perform less than 10 laparotomies annually.Conclusion: Implementation of the latest evidence regarding closure techniques of the abdominal wall is not widespread. Only 35% of surgeons close the abdominal fascia using a suture length to wound length ratio of 4:1, which is recommended based on the latest evidence. Surgical trainees, gastrointestinal and oncological surgeons are most familiar with the recommended technique and use it in their daily practice. Efforts should be directed at improving spreading of this technique.