Biomechanical parameters for prevention incisional hernia

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R. Villalobos, M. Mias, M. Nogués, C. Gas, J. Roca, E. Alfredo, L. Cabeza, J. Olsina

Moderator(s): Agneta Montgomery (Lund, Sweden) & Frederik Berrevoet (Ghent, Belgium)

10:00 - 10:15h at Jurriaanse Zaal

Categories: Session 1. Prevention incisional hernia

Parallel session: Session 1: Prevention incisional hernia

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Background:
Abdominal wall closure with tension causes ischemia in tissue, failure in the process of healing and consequently evisceration or incisional hernia depending on whether it is early or late respectively. We consider the hypothesis that, based on the knowledge of the biomechanical characteristics of the patient we could know tension strength of the abdominal wall closure and thus minimize the risk of dehiscence.

Methods:
Prospective nonrandomized 50 patients undergoing an elective or emergency midline laparotomy (MLP) from September 2012 to October 2013. Data collected included patients demographics, BMI, MLP length, MLP width, thickness of aponeurosis, tension strength on aponeurotic edges during closure, transverse and antero-posterior (AP) diameter of the abdomen. In addition, postoperative complications (surgical wound infection, evisceration, incisional hernia). We used a digital tensiometer, micrometer (Palmer) and a sterile measuring tape. Reference points were: umbilical level, supraumbilical (5 cms above) and infraumbilical (5 cms below)

Results:
50 patients (mean age=66.1, 68% male), mean BMI=27,81. The most frequent risk factors were hypoproteinemia (72%) and diabetes (44%). MLP length (mean =20,3 cms) being slightly higher supraumbilical (SU) length (10,7 cms); width was higher to umbilical level, the thickness was less to infraumbilical (IU) level (2.1 mm, p <0.001). Tension strength was higher at the umbilical level (9 Newton) with respect to SU (7N) followed by IU (6N) (p<0,001). Abdominal transverse diameter was 32,5 cms and AP 25.7 cms having this one a direct correlation with the tension strength (p<0,001). 3 patients developed an evisceration and 3 incisional hernia (1,5%). Mean follow-up period was 9,1 ± 5,6 months. 4 wound infection, one related evisceration.

Conclusions:
Tension strength along MLP is not the same and depend directly on AP diameter Although we didn´t find correlation of tensions with respect to other variables, is necessary to extend the study to more conclusive data