Abdominal wall incision hernias

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S

Abdominal Wall Incisional Hernias: Minimising the Risks in Open Gynaecological Surgery Adishesh M et al. Abdominal wall incisional hernias: techniques to minimise the risks in open gynaecological surgery. TOG 2024;26:209–212. doi:10.1111/tog.12949

3.5–16.9% 4× ≥4:1 IH INCIDENCE, OPEN GYNAE SURGERY MORE RE-ADMISSIONS WITH IH SUTURE:WOUND LENGTH RATIO TARGET

DO N' T-M IS S FA C TS

  1. IH incidence after open gynae surgery: 3.5–16.9%; 4× more re-admissions, 5× longer stay, 3× higher cost after IH post- hysterectomy

  2. Strongest hysterectomy risk factors: midline incision, malignancy, obesity, acute inflammatory process, smoking, anaemia, concurrent GI surgery

  3. Small bites technique: 5–9 mm bite, 5 mm step, aponeurosis only, USP 2/0 monofilament slowly absorbable suture, needle ≤31 mm, ratio ≥4:1

  4. Suture:wound ratio ≥4:1 → RR 0.42 (58% risk reduction); <4:1 → risk ×2.38

  5. Avoid mass closure (fat/muscle in stitch) – button-hole effect → necrosis → dehiscence/IH; aponeurosis alone is the key stable layer

  6. PDS® (monofilament, slow): >50% strength at 6 weeks, absorbed 6–8 months. Vicryl® (braided, fast): 25% strength at 4 weeks, absorbed 8–10 weeks

  7. Only 30% of surgeons use the small bites technique despite guideline endorsement

  8. NICE 2021: antimicrobial-coated sutures in SSI bundle – saves £13.62/patient; no proven IH-prevention benefit specifically

ABBREVIATION KEY

IH — incisional hernia SSI — surgical site infection

BMI — body mass index NICE — National Institute for Health and Care Excellence

ASA — American Society of Anaesthesiologists classification USP — United States Pharmacopeia

P-POSSUM — Portsmouth Physiological and Operative Severity PDS — polydioxanone (monofilament slowly absorbable suture) Score for the enUmeration of Mortality and Morbidity RCT — randomised controlled trial

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2024;26:209–212. doi:10.1111/tog.12949

Clinically reviewed by NHS obstetricians and gynaecologists

MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).

Included with a Pass Package

Start free