Effects of Different Abdominal Closure Techniques on Wound Healing

Abstract

Objective: Incisional hernias that are the type of anterior abdominal wall hernia (ventral hernia) are common surgical problems after abdominal procedures. Although these types of hernias are seen after every abdominal operation, they are mostly seen after the midline and transverse incisions. However, the incidence of incisional hernia is 20%, according to the latest data, the incidence of incisional hernia is 2-11%. Only in the U.S.A., 190 000 incisional hernia operations are carried out per year. Incisional hernias that are seen after abdominal surgical procedures cause important loss of labour, morbidity and adversely affect the quality of life. Because of the high incidence and morbidity rate, it is one of the important problems of surgery. Incisional hernias originated from previous insufficient healing of abdominal closure. Factors that cause incisional hernias are obesity, tight closure of wound edges, wound infection, hematoma, seroma, type of incision, the technique of abdominal closure, steroid use, malnutrition (hypoproteinemia), smoking, COPD, diabetes and mellitus. Methods: In this study, experimentally, we aimed to show the pathologic and biochemical effects of different closure techniques on wound healing into the cellular level of rats. Results: In this study, we used 40 female rats that were Wistar Albino types and their mean-weight was 200–250 gr. Rats were divided into five groups. Each group included eight rats. U-shaped samples were taken from mid-line incision, previously made, for pathologic (inflammation, angiogenesis and collagen activity) and biochemical [MDA (malondialdehyde), NO (nitric oxide), caspase 3 activity, MMP 2-9 (Metalloproteinases 2 and 9), TNF alfa (tumor necrosis factor alfa), IL6 (interleukin 6)] study, and after these procedures, rats were sacrificed. Conclusion: The findings obtained in this study show that there was no statistically significant difference between abdominal closure techniques one by one or continue suturing concerning incisional hernia if the fascia was closed optimally (not very tight, not to deteriorate the vascularity and end to end closing).

Keywords

• abdomen closing technique
• incisional hernia; wound healing.