Physiologic tension of the abdominal wall.
Abdominal closure
Abdominal wall tensiometry
Abdominal wall tension
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
24
03
2023
accepted:
30
07
2023
pubmed:
29
8
2023
medline:
29
8
2023
entrez:
28
8
2023
Statut:
ppublish
Résumé
Tension-free abdominal closure is a primary tenet of laparotomy. But this concept neglects the baseline tension of the abdominal wall. Ideally, abdominal closure should be tailored to restore native physiologic tension. We sought to quantify the tension needed to re-establish the linea alba in patients undergoing exploratory laparotomy. Patients without ventral hernias undergoing laparotomy at a single institution were enrolled from December 2021 to September 2022. Patients who had undergone prior laparotomy were included. Exclusion criteria included prior incisional hernia repair, presence of an ostomy, large-volume ascites, and large intra-abdominal tumors. After laparotomy, a sterilizable tensiometer measured the quantitative tension needed to bring the fascial edge to the midline. Outcomes included the force needed to bring the fascial edge to the midline and the association of BMI, incision length, and prior lateral incisions on abdominal wall tension. This study included 86 patients, for a total of 172 measurements (right and left for each patient). Median patient BMI was 26.4 kg/m In patients undergoing laparotomy, the tension needed to re-establish the linea alba is approximately 1.94 lbs. A quantitative understanding of baseline abdominal wall tension may help surgeons tailor abdominal closure in complex scenarios, including ventral hernia repairs and open or burst abdomens.
Sections du résumé
BACKGROUND
BACKGROUND
Tension-free abdominal closure is a primary tenet of laparotomy. But this concept neglects the baseline tension of the abdominal wall. Ideally, abdominal closure should be tailored to restore native physiologic tension. We sought to quantify the tension needed to re-establish the linea alba in patients undergoing exploratory laparotomy.
METHODS
METHODS
Patients without ventral hernias undergoing laparotomy at a single institution were enrolled from December 2021 to September 2022. Patients who had undergone prior laparotomy were included. Exclusion criteria included prior incisional hernia repair, presence of an ostomy, large-volume ascites, and large intra-abdominal tumors. After laparotomy, a sterilizable tensiometer measured the quantitative tension needed to bring the fascial edge to the midline. Outcomes included the force needed to bring the fascial edge to the midline and the association of BMI, incision length, and prior lateral incisions on abdominal wall tension.
RESULTS
RESULTS
This study included 86 patients, for a total of 172 measurements (right and left for each patient). Median patient BMI was 26.4 kg/m
CONCLUSION
CONCLUSIONS
In patients undergoing laparotomy, the tension needed to re-establish the linea alba is approximately 1.94 lbs. A quantitative understanding of baseline abdominal wall tension may help surgeons tailor abdominal closure in complex scenarios, including ventral hernia repairs and open or burst abdomens.
Identifiants
pubmed: 37640951
doi: 10.1007/s00464-023-10346-w
pii: 10.1007/s00464-023-10346-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
9347-9350Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Ochsner AJ (1902) Clinical surgery. Clinical Review Publishing Company, Cleveland
Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin N Am 93:1111–1133. https://doi.org/10.1016/j.suc.2013.06.010
doi: 10.1016/j.suc.2013.06.010
pubmed: 24035078
Zolin SJ, Rosen MJ (2021) Failure of abdominal wall closure: prevention and management. Surg Clin N Amer 101(5):875–888. https://doi.org/10.1016/j.suc.2021.07.001
doi: 10.1016/j.suc.2021.07.001
pubmed: 34537149
Madle K, Svoboda P, Stribrny M, Novak J, Kolar P, Busch A, Kobesova A, Bitnar P (2022) Abdominal wall tension increases using dynamic neuromuscular stabilization principles in different postural positions. Musculoskelet Sci Tract. https://doi.org/10.1016/j.msksp.2022.102655
doi: 10.1016/j.msksp.2022.102655
Novak J, Jacisko J, Busch A, Cerny P, Stribrny M, Kovari M, Podskalska P, Kolar P, Kobesova A (2021) Intra-abdominal pressure correlates with abdominal wall tension during clinic evaluation tests. Clin Biotech (Bristol, Avon). https://doi.org/10.1016/j.clinbiomech.2021.105426
doi: 10.1016/j.clinbiomech.2021.105426
Tenzel PL, Bilezikian J, Powers WF, Hope WW (2019) Physiologic tension: Technique for measuring and baseline values. Am Surg 85(9):998–1000
doi: 10.1177/000313481908500942
pubmed: 31638513
Lopez-Cano M, Garcia-Alamino JM, Antoniou SA, Bennet D, Dietz UA, Ferreira F, Fortelny RH, Hernandez-Granados P, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Pereira JA, Schwab R, Slater N, Vanlander A, Van Ramshorst GH, Berrevoet F (2018) EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen. Hernia 22:921–939. https://doi.org/10.1007/s10029-018-1818-9
doi: 10.1007/s10029-018-1818-9
pubmed: 30178226
Hope WW, Williams ZF, Rawles JW III, Hooks WB III, Clancy TV, Eckhauser FE (2018) Rationale and technique for measuring abdominal wall tension in hernia repair. Am Surg 84(9):1446–1449
doi: 10.1177/000313481808400947
pubmed: 30268173
Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang L-C, Tu C, Rosen MJ. Quantitative tension on the abdominal wall in posterior components separation with transversus abdominis release. JAMA Surg (accepted)
Zolin SJ, Krpata DM, Petro CC, Prabhu AS, Rosenblatt S, Rosen S, Thompson R, Fafaj A, Thomas JD, Huang L-C, Rosen MJ (2022) Long-term clinical and patient-reported outcomes after transversus abdominis release with permanent synthetic mesh: a single center analysis of 1203 patients. Ann Surg. https://doi.org/10.1097/SLA.0000000000005443
doi: 10.1097/SLA.0000000000005443
pubmed: 35793810
Bee TK, Croce MA, Magnotti LJ, Zarzaur BL, Maish GO III, Minard G, Schroeppel TJ, Fabian TC (2008) Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma 65:337–344. https://doi.org/10.1097/TA.0b013e31817fa451
doi: 10.1097/TA.0b013e31817fa451
pubmed: 18695468
Wehrle CJ, Shukla P, Miller BT, Blake KE, Prabhu AS, Petro CC et al (2023) Incisional hernia rates following midline laparotomy in the obese patient: a retrospective review. Hernia 27:557–563. https://doi.org/10.1007/s10029-022-02688-6
doi: 10.1007/s10029-022-02688-6
pubmed: 36318389