AUTHOR=Wenzelberg Charlotta , Petersson Ulf , Syk Ingvar , Ekberg Olle , Rogmark Peder 

TITLE=Abdominal Closure With Reinforcing Suture Decreases Incisional Hernia Incidence After CRS/HIPEC

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2023.11188

DOI=10.3389/jaws.2023.11188

ISSN=2813-2092

ABSTRACT=Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) entails several risk factors for incisional hernia (IH). A few reports available showing incidences between 7%- 17%. 
At our institution fascia closure has been performed in a 4:1 suture to wound length manner, with a continuous 2-0 polydiaxanone suture (PDS-group) or with a 2-0 polypropylene suture preceded by a reinforced tension line (RTL) suture (RTL-group). 
Our hypothesis was that these patients might benefit from reinforcing the suture line with a lower IH incidence in this group. The aim was to evaluate the one-year IH-incidence of the two different closures.
Methods
Patients eligible for inclusion were treated with CRS/HIPEC between 2004 and 2019. IH was diagnosed by scrutinizing CT-scans one year ± 3 months after surgery. Additional data was retrieved from clinical records and a prospective CRS/HIPEC-database.
Results
Of 193 patients, 129 were included, 82 in the PDS- and 47 in the RTL-group. RTL-patients were five years younger, had less blood loss and more frequent postoperative neutropenia. No difference regarding sex, BMI, recent midline incisions, excision of midline scars, peritoneal cancer index score, complications (≥Clavien-Dindo 3b), or chemotherapy. Ten IH (7.8%) were found, 9(11%) in the PDS- and 1(2.1%) in the RTL-group (p=0.071).
Conclusion
An IH incidence of 7.8% in patients undergoing CRS/HIPEC is not higher than after laparotomies in general. The IH incidence in the PDS-group was 11% compared to 2% in the RTL-group. Even though significance wasn´t reached, the difference is clinically relevant, suggesting an advantage with RTL suture.