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Abdominal Wall Closure

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Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction.
Rasilainen S, Mentula P, Salminen P, Koivukangas V, Hyöty M, Mäntymäki LM, Pinta T, Haikonen J, Rintala J, Rantanen T, Strander T, Leppäniemi A.
J Trauma Acute Care Surg. 2020 Dec;89(6):1136-1142.

Rationale for inclusion: Multicenter retrospective analysis of 676 patients. Outcomes showed superior role for vacuum-assisted closure with continuous mesh-mediate fascial traction in terms of successful primary fascial closure and increased survival rates following open abdomen. 

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The worst-case scenario: Bridging repair with a biologic mesh in high-risk patients with very large abdominal wall hernias - a prospective multicenter study.
Velmahos GC, Demetriades D, Mahoney E, Burke P, Davis K, Larentzakis A, Fikry K, El Moheb M, Kovach S, Schreiber M, Hassan M, Albrecht R, Dennis A.
Surgery. 2021 Feb;169(2):318-324.

Rationale for inclusion: This is a prospective, multicenter study that demonstrates acceptable outcomes for neonatal bovine dermis mesh (SurgiMend) in patients with very large hernias who cannot undergo midline fascial closure. 

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Negative pressure wound therapy vs conventional wound treatment in subcutaneous abdominal wound healing impairment: The SAWHI randomized clinical trial.
Seidel D, Diedrich S, Herrle F, Thielemann H, Marusch F, Schirren R, Talaulicar R, Gehrig T, Lehwald-Tywuschik N, Glanemann M, Bunse J, Hüttemann M, Braumann C, Heizmann O, Miserez M, Krönert T, Gletschel S, Lefering R.
JAMA Surg. 2020 Jun 1;155(6):469-478.

Rationale for inclusion: This is the first multicenter, multinational, randomized clinical trial to demonstrate that negative pressure wound therapy is superior to conventional wound therapy in time to closure for subcutaneous abdominal wounds.

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Prophylactic biologic mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial.
Reinforcement of Closure of Stoma Site (ROCSS) Collaborative and West Midlands Research Collaborate.
Lancet. 2020 Feb 8;395(10222):417-426.

Rationale for inclusion: Multicenter, randomized controlled trial demonstrating decrease in detectable incisional hernia 24 months after stoma closure without increased risk in wound infection, seroma formation or quality of life. 

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Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction
Clovin J, Rosen M, Prabhu A, Rosenblatt S, Petro C, Zolin S, Krpata D.
Surgery. 2019 Nov;166(5):849-853

Rationale for Inclusion: First study to demonstrate that an enhanced recovery protocol did not result in a change in outcomes inpatients undergoing complex abdominal wall reconstruction

CAVEAT: Small numbers

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The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma - A long-term prospective clinical trial
Birolini C, de Miranda J, Tanaka E, Utiyama E, Rasslan S, Birolini D.
Hernia. 2020 Apr;24(2);307-323

Rationale for Inclusion: This is a prospective trial that challenges the belief that synthetic mesh should not be used in a contaminated setting and shows similar outcomes

CAVEAT: Small numbers

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Increased incidence of surgical site infection with a body mass index =35 kg/m2 following abdominal wall reconstruction with open component separation
Docimo S, Spaniolas K, Svestka M, Bates A, Sbayi S, Schnur J, Talamini M, Pryor A.
Surg Endosc. 2019 Aug;33:2503-7

Rationale for Inclusion: This study used the ACS-NSQIP database and a large patient sample to quantify the impact of BMI on surgical site infections following elective abdominal wall reconstruction. It is the largest study to date and is consistent with the results of previously published studies.

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Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters
Pereira J, Bravo-Salva A, Montcusi B, Perez-Farre S, Prado de Fresno L, Lopez-Cano M.
BMC Surg. 2019 Aug;19(103);1-6

Rationale for Inclusion: Prospective study suggesting that specialized centers have lower rates of hernia recurrence than standard general surgeons. This is similar to findings in studies regarding other types of surgeries that indicate better outcomes with specialization

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Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial.
Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann H, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF.
Lancet. 2015 Sep 26;386(10000):1254-1260.

Rationale for inclusion: evidence-based technique for abdominal wall closure, 4:1 SWL ratio, not necessarily applicable in obese and emergency surgery

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