Suture Materials and Techniques for Midline Abdominal Closure

摘要

We thank Dr. Fujita for his very insightful comments on our recently published INSECT trial and agree that the overall 1-year incisional hernia rate of 12.3% in patients with a primary elective incision is of concern. Since 1998, 5 systematic reviews with meta-analyses focusing on abdominal wall closure have been published including 12,249 patients with different recommendations regarding suture techniques and mate-rials. This is most likely related to the selection of randomized controlled trials (RCTs) with different study populations including different incision types (midline and transverse) and different settings (emergency and elective patients). None of these reviews were published in cooperation with the Co-chrane Collaboration and therefore no update of the reviews incorporating new data from RCTs published thereafter is available. There are also considerable problems within the underlying RCTs of the systematic reviews themselves. Some used mixed study populations, definitions of outcome variables and assessment procedures varied, and follow-up periods were different. The lessons learned for the INSECT trial were: first, to define a homogenous study population; second, to state a hypothesis and calculate a sample size based on the findings of a systematic review; and third, to describe, educate and monitor the interventions as well as the outcomes.