Fascial Closure

Fascial Closure

Rachel Deborah Miller, MD

Table of Contents

Laparotomy Incision Closure
Port-Site Closure

See Also:
*See Difficult Abdominal Closure

Laparotomy Incision Closure

Optimal Technique

  • Continuous/Running Suture
  • Small Bites (5-7 mm Every 5-7 mm) – Largely Based on the STITCH Trial
  • Goal Suture:Wound Length: 4:1

Suture Selection

  • Slowly Absorbable Monofilament Suture is Generally Preferred
  • 2-0 PDS Was Used in the Classic STITCH Trial
  • Barbed Suture (Stratafix, V-Loc) May Decrease the Risk of Fascial Dehiscence and Evisceration
  • Triclosan-Coated Suture (Stratafix Symmetric, PDS Plus) May Decrease the Rates of Surgical Site Infections

Prophylactic Mesh Placement

  • May Decrease the Risk of Hernia
  • Onlay or Retro-Muscular Plane is Preferred
  • Complications:
    • Increased Risk of Seroma
    • No Increased Risk of Infection
  • *Use is Debated and Not Clearly Defined

Abdominal Binders

  • No Evidence to Show Decreased Risk of Incisional Hernia or Burst Abdomen
  • May Decrease Postoperative Pain

Fascial Closure 1

Port-Site Closure

Indications to Close the Fascial Defect

  • Trocar Sites ≥ 10 mm
  • Any Size After Single-Incision Laparoscopic Surgery (SILS)
  • Any Size at the Umbilical Site

Technique for Port-Site Closure

  • Over 20+ Techniques Have Been Described but There are Three General Groups
  • Intracorporeal Assistance – Require 2 Additional Ports (One to Visualize and One to Manipulate)
    • Maciol Needles
    • Grice Needles
    • Endoclose Suture Device
  • Extracorporeal Assistance – Require One Additional Port to Visualize
    • Carter-Thomason CloseSure System
    • Endo-Judge Wound Closure Device
    • Tahoe Surgical Instrument Ligature Device
  • External Closure – No Additional Ports Required
    • Suture Carrier
    • Dual-Hemostat Technique
    • Standard Hand Suture Closure

Carter-Thomason Device 2

References

  1. Rawstorne E, Smart CJ, Fallis SA, Suggett N. Component separation in abdominal trauma. J Surg Case Rep. 2014 Jan 20;2014(1):rjt133. (License: CC BY-NC-3.0)
  2. Eid GM, Thodiyil PA, Collins J, Bonanomi G, Mattar SG, Hughes SJ, Schauer PR, Wilson M. Laparoscopic repair of umbilical hernias in conjunction with other laparoscopic procedures. JSLS. 2006 Jan-Mar;10(1):63-5. (License: CC BY-NC-ND-3.0)