pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.34215/1609-1175-2022-2-75-77pmj-2342Research ArticleМЕТОДИКАMETHODSВыбор шовного материала и техники шва лапаротомной раныThe choice of suture material and techniques of the laparotomic wound suturehttps://orcid.org/0000-0003-4849-0320ВажничийА. К.VazhnichiyA. K.

Важничий Александр Константинович, врач-хирург хирургического отделения

683015, г. Петропавловск-Камчатский, ул. Аммональная Падь д.1

Alexandr K. Vazhnichiy, surgeon of the surgical department

1 Ammonal Pad street Petropavlovsk-Kamchatsky 683015

avazhnichiy@gmail.comНестеровИ. А.NesterovI. A.

Петропавловск-Камчатский

Petropavlovsk-Kamchatsky

Филиал № 2 федерального государственного казенного учреждения «1477 военно-морской клинический госпиталь»РоссияBranch № 2 of the Federal State-Funded Institution «1477 Naval Clinical Hospital»Russian Federation202223062022027577Copyright © Важничий А.К., Нестеров И.А., 20222022Важничий А.К., Нестеров И.А.Vazhnichiy A.K., Nesterov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/2342

Хирургическая техника и шовный материал, применяемые при ушивании лапаротомной раны, являются важными факторами, определяющими риск развития послеоперационных грыж и других раневых осложнений. Оптимизация закрытия лапаротомной раны, безусловно, уменьшит частоту послеоперационных осложнений, в том числе послеоперационных грыж и последующих вторичных операций у пациентов, тем самым будет способствовать улучшению их качества жизни и в экономическом плане значительному сокращению затрат на ресурсы здравоохранения. Несмотря на большую работу, проведенную в этом направлении многими группами медицинских специалистов и ученых во всем мире, на сегодняшний день нет единой, общепризнанной и имеющей доказанное преимущество методики закрытия лапаротомной раны.

Surgical technique and suture material applied in laparotomic wound suturing are important factors determining the risk of incisional hernias and other wound complications. Optimization of laparotomic wound closure will undoubtedly reduce the frequency of postoperative complications, including incisional hernias and subsequent secondary surgeries in patients. Thus it will improve their quality of life and, in economic terms, significantly reducing the cost of health care resources. Despite the great work carried out in this area by many groups of medical specialists and scientists around the world, today there is no single, generally accepted and proven advantage of the technique for closing a laparotomic wound.

лапаротомная ранашовный материалспособ наложения швовраневая инфекцияпослеоперационная грыжаlaparotomic woundsuture materialmethod of suturingwound infectionincisional herniaReferencesMeijer EJ, Timmermans L, Jeekel J, Lange JF, Muysoms FE. The principles of abdominal wound closure. Acta Chir Belg. 2013;113:239–44. doi: 10.1080/00015458.2013.11680920.Meijer EJ, Timmermans L, Jeekel J, Lange JF, Muysoms FE. The principles of abdominal wound closure. Acta Chir Belg. 2013;113:239–44. doi: 10.1080/00015458.2013.11680920.Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19:1–24. doi: 10.1007/s10029-014-1342-5.Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19:1–24. doi: 10.1007/s10029-014-1342-5.Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JCD, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J. Systematic Review and Meta- Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS ONE. 2015;10(9):e0138745. doi:10.1371/journal.pone.0138745.Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JCD, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J. Systematic Review and Meta- Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS ONE. 2015;10(9):e0138745. doi:10.1371/journal.pone.0138745.Le Huu Nho R, Mege D, Ouassi M, Sielezneff I, Sastre B. Incidence and prevention of ventral incisional hernia. J Visc Surg. 2012;149(5 Suppl):e3–e14. doi: 10.1016/j.jviscsurg.2012.05.004.Le Huu Nho R, Mege D, Ouassi M, Sielezneff I, Sastre B. Incidence and prevention of ventral incisional hernia. J Visc Surg. 2012;149(5 Suppl):e3–e14. doi: 10.1016/j.jviscsurg.2012.05.004.Kamarajah S K, Chapman SJ, Glaseby J Morton D, Smart N, Pinkney T, Bhangu A. Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure BJS Open. 2018;2:371–80. doi: 10.1002/bjs5.78.Kamarajah S K, Chapman SJ, Glaseby J Morton D, Smart N, Pinkney T, Bhangu A. Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure BJS Open. 2018;2:371–80. doi: 10.1002/bjs5.78.Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database of Syst Rev. 2017;11(11):CD005661. doi: 10.1002/14651858.CD005661.pub2.Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database of Syst Rev. 2017;11(11):CD005661. doi: 10.1002/14651858.CD005661.pub2.Chayla PL, Massinde AN, Kihunrwa A, Mabula JB. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Research Notes. 2015;8:281. doi: 10.1186/s13104-015-1243-4.Chayla PL, Massinde AN, Kihunrwa A, Mabula JB. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Research Notes. 2015;8:281. doi: 10.1186/s13104-015-1243-4.Bickenbach KA, Karanicolas PJ, Ammori JB Jayaraman S, Winter JM, Fields RC, Govindarajan A, Nir I, Rocha FG, Brennan MF. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg. 2013;206:400–09. doi: 10.1016/j.amjsurg.2012.11.008.Bickenbach KA, Karanicolas PJ, Ammori JB Jayaraman S, Winter JM, Fields RC, Govindarajan A, Nir I, Rocha FG, Brennan MF. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg. 2013;206:400–09. doi: 10.1016/j.amjsurg.2012.11.008.Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev. 2005;19;(4):CD005199. doi: 10.1002/14651858.CD005199.pub2.Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev. 2005;19;(4):CD005199. doi: 10.1002/14651858.CD005199.pub2.van ‘t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350–6. doi: 10.1046/j.1365-2168.2002.02258.x.van ‘t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350–6. doi: 10.1046/j.1365-2168.2002.02258.x.Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: the inline systematic review and meta-analysis. Ann Surg. 2010;251(5):843–56. doi: 10.1097/SLA.0b013e3181d973e4.Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: the inline systematic review and meta-analysis. Ann Surg. 2010;251(5):843–56. doi: 10.1097/SLA.0b013e3181d973e4.Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027–40. doi: 10.1016/j.suc.2013.06.009.Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027–40. doi: 10.1016/j.suc.2013.06.009.Sajid MS, Parampalli U, Baig MK, McFall MR. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg. 2011;9(8):615–25. doi: 10.1016/j.ijsu.2011.09.006.Sajid MS, Parampalli U, Baig MK, McFall MR. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg. 2011;9(8):615–25. doi: 10.1016/j.ijsu.2011.09.006.Gurusamy KS, Cassar Delia E, Davidson BR. Peritoneal closure versus no peritoneal closure for patients undergoing nonobstetric abdominal operations. Cochrane Database of Syst Rev. 2013;(7):CD010424. doi: 10.1002/14651858.CD010424.pub2.Gurusamy KS, Cassar Delia E, Davidson BR. Peritoneal closure versus no peritoneal closure for patients undergoing nonobstetric abdominal operations. Cochrane Database of Syst Rev. 2013;(7):CD010424. doi: 10.1002/14651858.CD010424.pub2.Israelsson LA. Bias in clinical trials: the importance of suture technique. Eur J Surg. 1999;165(1):3-7. doi: 10.1080/110241599750007432.Israelsson LA. Bias in clinical trials: the importance of suture technique. Eur J Surg. 1999;165(1):3-7. doi: 10.1080/110241599750007432.Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg. 2012;397(8):1201–7. doi: 10.1007/s00423-012-1019-4.Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg. 2012;397(8):1201–7. doi: 10.1007/s00423-012-1019-4.Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144(11):1056–9. doi: 10.1001/archsurg.2009.189.Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144(11):1056–9. doi: 10.1001/archsurg.2009.189.Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia. 2013;17(4):445–55. doi: 10.1007/s10029-013-1119-2.Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia. 2013;17(4):445–55. doi: 10.1007/s10029-013-1119-2.Nachiappan S, Markar S, Karthikesaligam A, Ziprin P, Faiz O. Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: a systematic review. World J Surg. 2013;37(8):1861–71. doi: 10.1007/s00268-013-2046-1.Nachiappan S, Markar S, Karthikesaligam A, Ziprin P, Faiz O. Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: a systematic review. World J Surg. 2013;37(8):1861–71. doi: 10.1007/s00268-013-2046-1.Timmermans L, de Goede B, Eker HH van Kempen BJH, Jeekel J, Lange JF. Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Dig Surg. 2013;30(4-6):401–9. doi: 10.1159/000355956.Timmermans L, de Goede B, Eker HH van Kempen BJH, Jeekel J, Lange JF. Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Dig Surg. 2013;30(4-6):401–9. doi: 10.1159/000355956.Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F. Prevention if incisional hernia by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment. Ann Surg. 2016;263:638–45. doi:10.1097/SLA.0000000000001369.Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F. Prevention if incisional hernia by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment. Ann Surg. 2016;263:638–45. doi:10.1097/SLA.0000000000001369.Zucker BE, Simillis C, Tekkis P, Kontovounisios C. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis. Ann R Coll Surg Engl. 2019;101:150–161. doi: 10.1308/rcsann.2018.0170.Zucker BE, Simillis C, Tekkis P, Kontovounisios C. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis. Ann R Coll Surg Engl. 2019;101:150–161. doi: 10.1308/rcsann.2018.0170.

The authors declare that there are no conflicts of interest present.