[Abdominal wall closure in laparotomy].

Abstract

The midline laparotomy is among the most common ways of accessing the peritoneal cavity. This approach is not only used for surgery of the digestive tract but is also extensively applied in vascular, gynecology and urological surgery. When this surgical procedure is conducted in an emergency setting, and depending on the type of surgery (clean and /or contaminated), the incidence of complications may be particularly high, especially when acute dehiscence of the wall occurs (evisceration). Furthermore, the rate of herniation related to midline laparotomy is still high at approximately 16% of cases. Despite efforts to evaluate different suture techniques, suture threads (reabsorbable or non-reabsorbable) and general factors that may interfere with the repair process, the incidence of complications associated with this approach has not been reduced. After multiple studies including meta-analyses, the outcome of laparotomy closure has not essentially improved. We should therefore consider the use of new ways of closing the abdomen in selected patients that might somehow reinforce the surgical wound and notably reduce the incidence of short- and medium-term complications. One such method could perhaps be the use of a biomaterial to support and strengthen conventional sutures.