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Title:           Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies
Subject:         DOI: 10.1093/bjs/znac302; British Journal of Surgery, 109, 12, 2022-8-26.; Abstract:  Background: Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. Methods: A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. Results: Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. Conclusion: These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
Keywords:        
Author:          Eva B. Deerenberg
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      Title: Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies
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        Title: Introduction
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        Title: Methods
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          Title: Guideline group
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          Title: Methodology and literature search
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          Title: Open and minimally invasive abdominal surgery
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           Item: 
            Title: KQ1a Which approach, minimally invasive or open, should be used in patients undergoing abdominal surgery?
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            Title: KQ 1b Which incision should be used in patients undergoing abdominal surgery?
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          Title: Closure of minimally invasive surgery ports
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            Title: KQ2 Should trocar sites be closed in patients undergoing laparoscopic surgery?
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          Title: Closure of laparotomy incisions
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            Title: KQ3 What is the preferred strategy for closing a laparotomy?
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          Title: Identifying patients with an increased risk of incisional hernia development
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           Item: 
            Title: KQ4 Which patients are at increased risk of incisional hernia development?
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            Title: KQ5a Is mesh augmentation beneficial for closure of elective laparotomies?
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            Title: KQ5b Which type of mesh should be used for prophylactic mesh augmentation?
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           Item: 
            Title: KQ5c Which abdominal plane should be used for prophylactic mesh augmentation?
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            Title: KQ5d Is mesh augmentation beneficial during closure of emergency laparotomies?
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            Title: KQ6 Are postoperative abdominal binders advantageous after open abdominal surgery?
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       Item: 
        Title: Acknowledgements
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        Title: Disclosure
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  Checksum: b2e77c42
   Type: CRC32
  Checksum: 1d4899d44dd184a9a0c432348c9f259b
   Type: MD5
  Checksum: 280321cc4a4b8610fe4f4fee383dd7ce5e2f4d53
   Type: SHA-1
  Checksum: f6b2bbde7ca67b4850a96a4aa350a7b12e6b1e9e45c529fde766907875880182
   Type: SHA-256