When do we have to use prostheses in burst abdomen? When reinforced tension line sutures?

Although uncommon, evisceration or wound dehiscence after a laparotomy is a feared complication due to its association with high morbidity and mortality. This postoperative pathology is also known as burst abdomen. The treatment concept is simple: the abdominal wall should be closed again. However, the reality can be much more difficult because of the local condition of the surgical field, with associated infections or significant bowel edema. In this lecture, Dr. Pilar Hernández Granados focuses on two aspects when closing a burst abdomen: the current situation of the reinforced tension line sutures and the need for a mesh. On the one hand, reinforced tension line sutures represent a contemporary closing method, with a significant potential for both elective and emergency settings, but the evidence about its effectiveness is scarce. On the other hand, using a mesh in a contaminated field (due to infections or enterocutaneous fistulas) carries a risk of mesh infection and need for its removal. Nevertheless, it decreases the risk of an incisional hernia. Several studies have been conducted, and it seems that there could be some exceptions to the traditional notion that “no mesh should be placed in contaminated fields”. The general surgeon must individualize the case, taking into account patient-related factors, the surgical technique and mesh characteristics.