The incidence of incisional hernia after aortic aneurysm is not higher than after benign colorectal interventions: A retrospective control-matched cohort study

Suture-TOOL: A suturing device for swift and standardized abdominal aponeurosis closure

Introduction

Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing.

Method

Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15 cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-Tool user impressions was completed.

Results

A SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p < 0.001). Suture time was shorter for Suture-TOOL (p < 0.001). Wound stitch count was higher for Needle-Driver (p = 0.013). The median SL/WL-ratio was similar between groups. The learning curve plateaued after three closures using Suture-TOOL. Two glove punctures were detected-all in the Needle-Driver group. Suture-TOOL received high VAS scores for all measured functionalities.

Conclusion

Suture-TOOL is a promising device for clinical use. It is safe, easy, and fast resulting in a high-quality suture lines with a short learning curve and a high functionality ranking.

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Background

This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy.

Methods

A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m²), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development.

Results

Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m² and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m² (p=0.03).

Conclusion

High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Do Hernias Contribute to Increased Severity of Aneurysmal Disease among Abdominal Aortic Aneurysm Patients?

Background  Connective tissue disorders could contribute to the pathogenesis of both abdominal aortic aneurysms (AAA) and hernias. We tested the hypothesis that hernias in AAA patients contribute to increased severity of the aneurysmal disease.

Methods  A questionnaire was used to collect information from 195 AAA patients divided into four groups: (1) survivors ( n  = 22) of ruptured AAA, (2) patients ( n  = 90) after elective open repair, (3) patients ( n  = 43) after elective endovascular repair (EVAR), and (4) patients ( n  = 40) under surveillance of AAA. The control group consisted of 100 patients without AAA whose abdominal computed tomography (CT) scans were examined for the presence of hernias. Mann–Whitney U -test, Chi-squared ( χ² ) test, or Fisher's exact test (as appropriate) were used for statistical analyses. Multivariate logistic regression was used to control for potential confounding variables such as sex and age.

Results  The prevalence of inguinal hernias was significantly higher in the AAA than the control group (25 vs. 9%, p  = 0.001) and did not differ between the AAA subgroups (9, 24, 35, and 23% in subgroups 1 through 4, respectively, p  = 0.15) based on univariate analysis. The prevalence of inguinal hernias did not differ ( p  = 0.15) between the two open surgery groups (groups 1 and 2), or when comparing all three operative procedures as a combined group to group 4 ( p  = 0.73). The prevalences of incisional hernias were 18 and 24% for groups 1 and 2, respectively, with no significant difference ( p  = 0.39). Inguinal hernia demonstrated a significant association with AAA on multivariate analysis ( p  = 0.006; odds ratio [OR] = 4.00; 95% confidence interval [CI] = 1.49–10.66).

Conclusions  Our study confirms previous observations that patients with AAA have a high prevalence of hernias. Our results suggest that hernias do not contribute to increased severity of the aneurysmal disease.