N. S. Patel1, L. A. Israelsson2, J. S. Thompson1, D. J. Zhou1, S. Aravind1, M. A. Carlson1 1University Of Nebraska College Of Medicine,General Surgery,Omaha, NE, USA 2Sundsvall Sjukhus,Surgery,Sundsvalls, Sweden
Introduction:
Prevailing opinion has de-emphasized the surgeon as a risk factor for ventral-incisional hernia (VIH); however,
recent controlled data has suggested that VIH risk is surgeon-dependent. Our objective was to determine the
relationship of surgeon-dependent factors with VIH incidence in published data.
Methods:
A systematic review was performed on comparative studies (1960–2015) which determined the effect of incision
choice (vertical midline=VMI; transverse=TI, lateral paramedian=LPI), suture use (nonabsorbable=NA, rapidly
absorbable=RA, slowly absorbable=SA), closure technique (mass vs. layered), or stitch length (VMI only; short
vs. long) on the incidence of primary VIH after uncomplicated laparotomy in adults. Exclusion criteria were
follow-up <12 months, <40 incisions/treatment group, and/or presenceof AAA, immunosuppression, mini-
laparotomy, and/or mesh implantation.
Results:
In 42 comparative studies (median incisions/treatment group=115; range=45–1,111) including 32 controlled trials,
1,383 primary VIHs developed from 15,305 incisions (raw VIH rate=9.0%;median rate=7.7%; range=0–29.2%).
Selection of TI or LPI instead of VMI in the incision category or use of short as opposed to long stitch length (for
VMI) produced an ~80% or ~60% decrease in median VIH incidence, respectively (Fig.1).
Conclusion:
Large differences in VIH rate in studies comparing incisional choice or stitch length suggested that these two
surgeon-dependent factors influence VIH incidence. To minimize VIH formation, published data support
selection of TI or LPI for incision, or short stitch length if VMI is selected.
