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Could Mesh Sutures Reduce Incisional Hernias

March 3, 2016

Incisional Hernias

Incisional Hernias

Incisional hernias are among the most common complications of abdominal wall closures. A landmark study found that about 20% of patients developed an incisional hernia after a laparotomy (Chirurg2002;73:474-480).

Failures of high-tension repairs may come down to the inability of sutures to reliably appose tissues. Even though modern sutures are sufficiently strong and resist breaking, abdominal wall closures can fail because the sutures abruptly or slowly pull through the fascia.

“In abdominal wall closures, we often see signs of suture pull-through,” said Gregory Dumanian, MD, chief of plastic surgery at Northwestern University Feinberg School of Medicine and Northwestern Hospital, both in Chicago. “Just like a cheese wire, the sharp suture can physically cut through tissue and can cause an incisional hernia.”

The incidence of incisional hernias remains high, with an estimated 100,000 to 300,000 repairs performed in the United States each year, according to surgeons who were interviewed for this article. Surgeons have been exploring ways to prevent incisional hernia formation and recurrences. For laparotomy closures, some studies have recommended using a small-bite technique (BMC Surg2011;11:20). Other studies have proposed placing mesh prophylactically (BMC Surg 2013;13:48) to recreate the improved outcomes of mesh over suture repairs of incisional hernias (Ann Surg 2004;240:578-585).

Recently, Dr. Dumanian introduced a novel mesh suture that may decrease incisional hernia formation and recurrences. Mesh suture, essentially an open braided polypropylene suture, can enhance the force distribution at the level of the suture and improve biocompatibility, according to Dr. Dumanian. The suture apposes the tissue, while the tissue holds onto the macroporous suture. Together, these characteristics may allow for earlier wound strength, better tissue integration and less suture pull-through.

The idea for a new suture emerged when Dr. Dumanian was a general surgery resident contemplating the problem of suture pull-through after laparotomy closures. “When I would perform high-tension closures, the pressure of the suture would cut straight through my glove and tear the skin of my index finger,” Dr. Dumanian said. If sutures could cut through a surgeon’s finger, Dr. Dumanian considered the damage it could do inside a patient’s body.

Read More – Source: Surgeon Explores Mesh Sutures for Reducing Incisional Hernia Rates – General Surgery News

By Victoria Stern

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