Standardized Fascial Closure Technique in Patients Undergoing an Emergency Laparotomy
Abdominal fascial dehiscence is a serious complication of laparotomy and is reported to vary between 0.2% and 5% in elective surgery in clinical settings and at a higher rate ranging between 8.5% and 45% in an emergency setting. Dehiscence is associated with an increase in morbidity and mortality rates by up to 30 %, prolonged hospital stays, and a long-term risk of developing incisional hernia. In elective surgery, it is well documented that a midline laparotomy should be closed with a slowly absorbable monofilament suture material in a continuous technique, suturing only the fascia, in a suture to wound-length ratio of at least 4 : 1. By using this technique, the rate of fascial dehiscence has been recently reported to be as low as 1% and it has been shown to reduce the rate of surgical site infection and to reduce the risk of developing incisional hernia. The evidence concerning the suture material or suturing technique in an emergency setting is lacking. In this lecture, Mai-Britt Tolstrup presents the results and conclusions of her study evaluating a new technique that would reduce the rate of fascial dehiscence after an emergency laparotomy with the introduction of a standardized abdominal fascial closure technique. This consists of slowly absorbable (polydioxanone) suture material in a continuous suturing ‘‘small steps’’ technique in a minimum wound-suture ratio of 1 : 4.
