Contemporary Global Practice in Dissection and Closure Techniques for Lower Abdominal Transverse Incisions: A Cross-Sectional Survey

Abstract

Purpose: To characterise international contemporary practice in dissection and closure of lower abdominal transverse incisions (LATI) across surgical specialties. Methods: An open, cross-sectional survey of surgeons with experience of performing LATI independently was conducted using an anonymised online questionnaire disseminated via professional networks. Data were captured pertaining to respondent characteristics, operative techniques for dissection and closure of abdominal layers, and experience with incisional hernias related to these incisions. Results: Overall, 231 respondents from 31 countries across 6 continents were included, following relevant exclusions. Respondents comprised general surgeons (68.4%), obstetricians and gynaecologists (O&G; 26.4%) and urologists (5.2%). O&G respondents performed a significantly higher annual LATI case volume, when compared to other specialists (>50 cases / year: 60.7% vs. 6.5%, p<0.001). Peritoneal entry varied between O&G and other surgeons, with O&G more commonly using blunt peritoneal entry (62.3% vs. 7.6%, p<0.001) and a transverse, rather than longitudinal, peritoneal opening (54.1% vs. 15.9%, p<0.001). Rates of peritoneal non-closure were higher amongst O&G compared to other subspecialties (77.0% vs. 24.1%, p<0.001). More frequent use of a 'small bites' fascial closure technique was noted among general surgeons and urologists (85.3%), when compared to O&G (42.6%, p<0.001). Most respondents considered LATI hernias to be underreported (84.0%), however more general surgeons had encountered LATI hernias (general surgery: 85.4%, urology: 41.7% and O&G: 42.6%, p<0.001). Conclusion: There is substantial inter-specialty variation in closure techniques for LATI. Differences in practice may influence incisional hernia development and reporting, highlighting a need for further outcome-focused research and standardisation.