Laparotomy closure – do we know how?
(Guideline of the European Hernia Society)

Czech version

Authors: B. East ¹; F. E. Muysoms ²
Authors‘ workplace: Chirurgická klinika 2. LF UK a FN Motol, Praha, Česká republika, přednosta: prof. MUDr. J. Hoch, CSc. ¹; AZ Maria Middelares – Campus Sint-Jozef, Ghent, Belgie a skupina autorů Pracovní skupiny pro závěr laparotomie při Evropské kýlní společnosti. (S. A. Antoniou, K. Bury, G. Campanelli, J. Conze, D. Cuccurullo, A. C. de Beaux, E. B. Deerenberg, R. H. Fortel ²
Published in: Rozhl. Chir., 2015, roč. 94, č. 2, s. 57-63.
Category: Recommended procedure

Overview

The recurrence rate of surgical treatment of incisional hernia is high. The material and surgical technique used to close the abdominal wall following every surgery contribute as important risk factors in incisional hernia formation. However, by optimising abdominal wall closure, many patients can be spared from developing this type of complication. The European Hernia Society has established a Guidelines Development Group with a goal to research the literature and write a series of recommendations of how to close the abdomen and minimize the risk of incisional hernia in accordance with the principles of evidence-based medicine. To decrease the incidence of incisional hernias, the following is recommended:

To utilise a non-midline approach to a laparotomy whenever possible.
To perform a continuous suturing technique using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique.
To perform the small bites technique with a suture to wound length (SL/WL) ratio at least 4/1.
Not to close the peritoneum separately.
To avoid rapidly resorbable materials.
To consider using a prophylactic mesh in high-risk patients.
To use the smallest trocar size adequate for the procedure and closing the fascial defect if trocars larger or equal to 10 mm are used in laparoscopic surgery.

Key words:
incisional hernia− laparotomy − laparotomy closure −suturing material

Sources

1. Diener MK, Voss S, Jensen K, et al. Elective midline laparotomy closure: The inline systematic review and meta-analysis. Annals of Surgery 2010;251:843−56.

2. Fink C, Baumann P, Wente MN, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg 2014;101:51−4.

3. Pereira JA, Pera M, Grande L. Incidence of incisional hernia after open and laparoscopic colorectal cancer resection. (Spanish language) Cir Esp 2013;91:44−9.

4. Claes K, Beckers R, Heindryckx E, et al. Retrospective observational study on the incidence of incisional hernias after colorectal carcinoma resection with follow-up CT scan. Hernia 2014 (Epub ahead of print).

5. den Hartog D, Dur AHM, Kamphuis AGA, et al. Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 2013;13:45−8.

6. Bloemen A, Van Dooren P, Huizinga BF, et al. Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia 2013;16:53−7.

7. Bosanquet D, Aboelrahman T, Ansell J, et al. Systematic review and meta regression of factors affecting midline incisional hernia rates: an analysis of 14,618 patients. Hernia 2014;18(suppl 2):S12−S15.

8. Alnassar S, Bawahab M, Abdoh A, et al. Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular 2012;20:273−7.

9. Höer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 2002;73:474−80.

10. Antoniou GA, Georgiadis GS, Antoniou SA, et al. Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder. J Vasc Surg 2011;54:1175−81.

11. Henriksen NA, Helgstrand F, Vogt KC, et al. Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study. J Vasc Surg, 2013; 57:1524−30.

12. Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am 2013;93:1027−40.

13. van Ramshorst GH, Eker HH, Hop WC, et al. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg, 2012;204:144−50.

14. Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg, 2003;237:129−35.

15. Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578−83.

16. Helgstrand F, Rosenberg J, Kehlet H, et al. Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 2012;256:955−8.

17. Meijer EJ, Timmermans L, Jeekel J, et al. The principles of abdominal wound closure. Acta Chir Belg 2013;113:239−44.

18. Data presented by J-F Gillion during the 36th Annual Congress of the European Hernia Society in Edinburgh on May 31st 2014. (Publication in preparation: Gillion J-F, Sanders D, Miserez M, et al. The Bonham Group. The economic burden of incisional hernia repair.)

19. Scottish Intercollegiate Guidelines Network (SIGN). Dostupný na http://www.sign.ac.uk/.

20. Brouwers M, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J 2010; 182:E839−42. Dostupný na http://www.agreetrust.org/.

21. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1−e34. Dostupný na http://www.prisma-statement.org/.

22. Guyatt GH, Oxman AD, Vist G, et al. Rating quality of evidence and strength of recommendations GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336:924−6. Dostupný na http://www.gradeworkinggroup.org/.

23. Anderson ER, Gates S. Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database Syst Rev 2004;18:CD004663.

24. Bhangu A, Fitzgerald JE, Singh P, et al. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia 2013;17:445−55.

25. Bhangu A, Nepogodiev D, Futaba K. Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg 2012;36:973−83.

26. Bickenbach KA, Karanicolas PJ, Ammori JB, et al. 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;206:400−9.

27. Brown SR, Goodfellow PB. Transverse versus midline incisions for abdominal surgery. Cochrane Database Syst Rev 2005;4:CD005199.

28. Cheng H, Rupprecht F, Jackson D, et al. Decision analysis model of incisional hernia after open abdominal surgery. Hernia 2007;11:129−37.

29. Finan KR, Kilgore ML, Hawn MT. Open suture versus mesh repair of primary incisional hernias: A cost-utility analysis. Hernia 2009;13:173−82.

30. Friedrich M, Muller-Riemenschneider F, Roll S, et al. Health technology assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness. GMS Health Technol Assess 2008;4:Doc01.

31. Grantcharov TP, Rosenberg J. Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 2001;167:260−7.

32. Gupta H, Srivastava A, Menon GR, at al. Comparison of interrupted versus continuous closure in abdominal wound repair: A meta-analysis of 23 trials. Asian J Surg 2008;31:104−14.

33. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: A qualitative systematic review. Hernia 2011;15:113−21.

34. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: A meta-analysis. Ann Surg 2000;231:436−42.

35. Hynes DM, Stroupe KT, Luo P, et al. Cost effectiveness of laparoscopic versus open mesh hernia operation: Results of a department of veterans affairs randomized clinical trial. J Am Coll Surg 2006;203:447−57.

36. Mathai M, Hofmeyr GJ, Mathai NE. Abdominal surgical incisions for caesarean section. Cochrane Database Syst Rev 2013;5:CD004453.

37. Jin JB, Jiang ZP, Chen S. Meta-analysis of suture techniques for midline abdominal incisions. Zhonghua Wai Ke Za Zhi (Chinese Journal of Surgery) 2010;48:1256−61.

38. Le Huu Nho R, Mege D, Ouaïssi M, et al. Incidence and prevention of ventral incisional hernia. J Visc Surg 2012;149(5 Suppl):e3−14.

39. Nachiappan S, Markar S, Karthikesaligam A, et al. Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: A systematic review. World J Surg 2013;37:1861−71.

40. Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011;9:218−24.

41. Pemberton RJ, Tolley DA, van Velthoven RF. Prevention and management of complications in urological laparoscopic port site placement. Eur Urol 2006;50:958−68.

42. Rucinski J, Margolis M, Panagopoulos G, et al. Closure of the abdominal midline fascia: Meta-analysis delineates the optimal technique. Am Surg 2001;67:421−6.

43. Sajid MS, Parampalli U, Baig MK, et al. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg 2011;9:615−25.

44. Seiler CM, Bruckner T, Diener MK, et al. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: A multicenter randomized trial. Ann Surg 2009;249:576−82.

45. Seiler CM, Deckert A, Diener MK, et al. Midline versus transverse incision in major abdominal surgery: A randomized, double-blind equivalence trial. Ann Surg 2009;249:913−20.

46. Swank HA, Mulder IM, la Chapelle CF, et al. Systematic review of trocar-site hernia. Br J Surg 2012;99:315−23.

47. Takagi H, Sugimoto M, Kato T, et al. Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: A systematic review. Eur J Vasc Endovasc Surg 2007;33:177−81.

48. van ‘t Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 2002;89:1350−6.

49. Yamamoto M, Minikel L, Zaritsky E. Laparoscopic 5-mm trocar site herniation and literature review. JSLS 2011;15:122−6.

50. Baucom RB, Beck WC, Holzman MD, et al. Prospective evaluation of surgeon physical exam for detection of incisional hernia. J Am Coll Surg 2014;218:363−6.

51. Beck WC, Holzman MD, Sharp KW, et al. Comparative effectiveness of dynamic abdominal sonography for hernia vs computed tomography in the diagnosis of incisional hernia. J Am Coll Surg 2013;216:447−53.

52. Schreinemacher MH, Vijgen GH, Dagnelie PC, et al. Incisional hernias in temporary stoma wounds: a cohort study. Arch Surg 2011;146:94−9.

53. Bhangu A, Fletcher L, Kingdon S, et al. A clinical and radiological assessment of incisional hernias following closure of temporary stomas. Surgeon 2012;10:321−5.

54. Cingi A, Cakir T, Sever A, Aktan AO. Enterostomy site hernias: A clinical and computerized tomographic evaluation. Dis Colon Rectum 2006;49:1559−63.

55. Cingi A, Solmaz A, Attaallah W, et al. Enterostomy closure site hernias: A clinical and ultrasonographic evaluation. Hernia 2008;12:401−5.

56. Musella M, Milone F, Chello M, et al. Magnetic resonance imaging and abdominal wall hernias in aortic surgery. J Am Coll Surg 2001;193:392−5.

57. Rodriguez HE, Matsumura JS, Morasch MD, et al. Abdominal wall hernias after open abdominal aortic aneurysm repair: Prospective radiographic detection and clinical implications. Vasc Endovasc Surg 2004;38:237−40.

58. Hojer AM, Rygaard H, Jess P. CT in the diagnosis of abdominal wall hernias: A preliminary study. Eur Rad 1997;7:1416−8.

59. Young J, Gilbert AI, Graham MF. The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia 2007;11:347−51.

60. Lee L, Mappin-Kasirer B, Liberman AS, et al. High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 2012;26:3180−5.

61. Burger JW, van ‘t Riet M, Jeekel J. Abdominal incisions: techniques and postoperative complications. Scand J Surg 2002;91:315−21.

62. Weiland DE, Bay C, Del Sordi S. Choosing the best abdominal closure by meta-analysis. Am J Surg 1998;176:666–70.

63. Gurusamy KS, Cassar Delia E, et al. Peritoneal closure versus no peritoneal closure for patients undergoing non-obstetric abdominal operations. Cochrane Database Syst Rev, 2013; Issue 7. Art. No. CD010424.

64. Israelsson LA. Bias in clinical trials: the importance of suture technique. Eur J Surg 1999; 165:3−7.

65. Nelson RL, Vedula SS. Closure methods for laparotomy incisions. Cochrane Database Systc Rev 2006; Issue 1. Art. No. CD005661.

66. Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg 1976; 63:873−6.

67. Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 1993;80:1284−6.

68. Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg 2012;397:1201−07.

69. 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;144:1056−9.

70. Wissing J, van Vroonhoven TJ, Schattenkerk ME, et al. Fascia closure after midline laparotomy: results of a randomized trial. Br J Surg 1987;74:738–41.

71. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2013;100:465−73.

72. Diener MK, Knebel P, Kieser M, et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 2014;384:142−52.

73. Rasić Z, Schwarz D, Adam VN, et al. Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl* Plus) suture for closure of the abdominal wall after colorectal surgery. Coll Antropol 2011;35:439−43.

74. Nakamura T, Kashimura N, Noji T, et al. Triclosan-coated sutures reduce the incidence of wound infections and the costs after colorectal surgery: a randomized controlled trial. Surgery 2013;153:576−83.

75. Justinger C, Slotta JE, Ningel S, et al. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial. Surgery 2013;3:589−95.

76. Baracs J, Huszár O, Sajjadi SG, et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study. Surg Infect (Larchmt) 2011; 12:483−9.

77. Stafford MK, Pitman MC, Nanthakumaran N, et al. Blunt-tipped versus sharp-tipped needles: wound morbidity. Journal of Obstetrics and Gynaecology 1998;18:18–9.

78. Khorgami Z, Shoar S, Laghaie B, et al. Prophylactic retention sutures in midline laparotomy in high-risk patients for wound dehiscence: a randomized controlled trial. J Surg Res 2013;180:238−43.

79. Agarwal A, Hossain Z, Agarwal A, et al. Reinforced tension line suture closure after midline laparotomy in emergency surgery. Trop Doct 2011;41:193−6.

80. Rink AD, Goldschmidt D, Dietrich J, et al. Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study. Eur J Surg 2000;166:932−7.

81. Mäkelä JT, Kiviniemi H, Juvonen T, et al. Factors influencing wound dehiscence after midline laparotomy. Am J Surg 1995;170:387−90.

82. Matsuoka J, Gohchi A, Kamikawa Y, et al. Chopstick retention suture for the closure of abdominal wounds. J Am Coll Surg 1995;181:471−4.

83. Penninckx FM, Poelmans SV, Kerremans RP, et al. Abdominal wound dehiscence in gastroenterological surgery. Ann Surg 1979;189:345−52.

84. Irvin TT, Stoddard CJ, Greaney MG, et al. Abdominal wound healing: a prospective clinical study. Br Med J 1977;2:351−2.

85. Hubbard TB Jr, Rever WB Jr. Retention sutures in the closure of abdominal incisions. Am J Surg 1972;124:378−80.

86. Rahbari NN, Knebel P, Diener MK, at al. Current practice of abdominal wall closure in elective surgery – is there any consensus? BMC Surgery 2009;9:8.

87. Bouvier A, Rat P, Drissi-Chbihi F, et al. Abdominal binders after laparotomy: review of the literature and French survey of policies. Hernia 2014;18:501−6.

88. Pommergaard HC, Burcharth J, Danielsen A, et al. No consensus on restrictions on physical activity to prevent incisional hernias after surgery. Hernia 2013;18:495−500.

89. Kosins AM, Scholz T, Cetinkaya M, et al. Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg 2013;132:443−50.

90. Nakayama H, Takayama T, Okubo T, et al. Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial. J Hepatobiliary Pancreat Sci 2014;21:509−17.

91. Numata M, Godai T, Shirai J, et al. A prospective randomized controlled trial of subcutaneous passive drainage for the prevention of superficial surgical site infections in open and laparoscopic colorectal surgery. Int J Colorectal Dis 2014;29:353−8.

92. Kaya E, Paksoy E, Ozturk E, et al. Subcutaneous closed-suction drainage does not affect surgical site infection rate following elective abdominal operations: a prospective randomized clinical trial. Acta Chir Belg 2010;110:457−62.

93. Baier PK, Gluck NC, Baumgartner U, et al. Subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients. Int J Colorectal Dis 2010;25:639−43.

94. Chowdri NA, Qadri SA, Parray FQ, et al. Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: A cohort study. Int J Surg 2007;5:404−7.

95. Panici PB, Zullo MA, Casalino B, et al. Subcutaneous drainage versus no drainage after minilaparotomy in gynecologic benign conditions: a randomized study. Am J Obstet Gynecol 2003;188:71−5.

96. Gallup DC, Gallup DG, Nolan TE, et al. Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol, 1996;175:358–361.

97. Loong RL, Rogers MS, Chang AM. A controlled trial on wound drainage in caesarean section. Aust N Z J Obstet Gynaecol 1988;28:266−9.

98. Shaffer D, Benotti PN, Bothe A Jr, et al. A prospective, randomized trial of abdominal wound drainage in gastric bypass surgery. Ann Surg 1987;206:134−7.

99. Ali J, Serrette C, Khan TA. The effect of abdominal binders on postoperative pulmonary function. Infect in Surg 1983;2:875–81.

100. Fagevik Olse´n M, Josefson K, Wiklund M. Evaluation of abdominal binder after major upper gastrointestinal surgery. Adv in Physiother 2009;11:104–10.

101. Larson CM, Ratzer ER, Davis-Merritt D, et al. The effect of abdominal binders on postoperative pulmonary function. Am surg 2009;75:169–71.

102. Cheifetz O, Lucy SD, Overend TJ, et al. The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiother Can 2010;62:242–53.

103. Clay L, Gunnarsson U, Franklin KA, et al. Effect of an elastic girdle on lung function, intra-abdominal pressure, and pain after midline laparotomy: a randomized controlled trial. Int J Colorectal Dis 2014; 29:715−21.

104. Timmermans L, de Goede B, Eker HH, et al. Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional Hernia. Dig Surg, 2013;30:401−9.

105. Abo-Ryia MH, El-Khadrawy OH, Abd-Allah HS. Prophylactic preperitoneal mesh placement in open bariatric surgery: a guard against incisional hernia development. Obes Surg 2013;23:1571–4.

106. Caro-Tarrago A, Olona Casas C, Jimenez Salido A, et al. Prevention of Incisional Hernia in Midline Laparotomy with an Onlay Mesh: A Randomized Clinical Trial. World J Surg 2014;38:2223−30.

107. Gutiérrez de la Pena C, Medina Achirica C, Dominguez-Adame E, et al. Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness. Hernia 2003;7:134–6.

108. Strzelczyk JM, Szymanski D, Nowicki ME, et al. Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 2006;93:1347–50.

109. El-Khadrawy OH, Moussa G, Mansour O, et al. Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 2009;13:267–74.

110. Bevis PM, Windhaber RA, Lear PA, et al. Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 2010;97:1497–1502.

111. Pans A, Elen P, Desaive C, Andre C. Long-term results of polyglactin mesh for the prevention of incisional hernias in obese patients. World J Surg 1998;22:479–83.

112. Llaguna OH, Avgerinos DV, Nagda P, et al. Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 2011;35:1651–5.

113. Armañanzas L, Ruiz-Tovar J, Arroyo A, et al. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 2014;218:960−8.

114. Bhoyrul S, Payne J, Steffes B, Swanstrom L, et al. A randomized prospective study of radially expanding trocars in laparoscopic surgery. J Gastrointest Surg 2000;4:392−7.

115. Bonjer HJ, Hazebroek EJ, Kazemier G, et al. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 1997;84:599−602.

116. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 2001;15:663−6.

117. Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS 2010;14:490−7.

118. Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg, 2006; 16:913−8.

119. Clark LH, Soliman PT, Odetto D, et al. Incidence of trocar site herniation following robotic gynecologic surgery. Gynecol Oncol 2013;131:400−3.

120. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207:1−6.

121. Delmonaco P, Cirocchi R, La Mura F, et al. Trocarsite hernia after laparoscopic colectomy: A case report and literature review. ISRN Surgery 2011;7 pages.

122. Eid GM, Collins J. Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients. Obes Surg 2005;15:871−3.

123. Erdas E, Dazzi C, Secchi F, Aresu S, et al. Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: a long-term follow-up study. Hernia 2012;16:431−7.

124. Feste JR, Bojahr B, Turner DJ. Randomized trial comparing a radially expandable needle system with cutting trocars. JSLS 2000;4:11−5.

125. Helgstrand F, Rosenberg J, Kehlet H, et al. Low risk of trocar site hernia repair 12 years after primary laparoscopic surgery. Surg Endosc 2011;25:3678−82.

126. Holzinger F, Klaiber C. Trocar site hernias. A rare but potentially dangerous complication of laparoscopic surgery. Chirurg 2002;73:899−904.

127. Hussain A, Mahmood H, Singhal T, et al. Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 2009;13:346−49.

128. Johnson WH, Fecher AM, McMahon RL, et al. VersaStep trocar hernia rate in unclosed fascial defects in bariatric patients. Surg Endosc 2006;20:1584−6.

129. Kadar N, Reich H, Liu CY, et al. Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol 1993;168:1493−5.

130. Leibl BJ, Schmedt CG, Schwarz J, et al. Laparoscopic surgery complications associated with trocar tip design: review of literature and own results. J Laparoendosc Adv Surg Tech A 1999;9:135−40.

131. Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, et al. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997;21:529−33.

132. Moran DC, Kavanagh DO, Sahebally S, et al. Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach. Ir J Med Sci 2012;181:463−6.

133. Moreno-Sanz C, Picazo-Yeste JS, Manzanera-Díaz M, et al. Prevention of trocar site hernias: description of the safe port plug technique and preliminary results. Surg Innov 2008;15:100−4.

134. Sánchez-Pernaute A, Pérez-Aguirre E, García Botella A, et al. Prophylactic closure of trocar orifices with an intraperitoneal mesh (ventralex) in laparoscopic bariatric surgery. Obes Surg 2008;18:1489−91.

135. Schmedt CG, Leibl BJ, Däubler P, et al. Access-related complications – an analysis of 6023 consecutive laparoscopic hernia repairs. Min Invas Ther & Allied Technol, 2001;10:23−30.

136. Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia. Arch Surg 2014;139:1248−56.

137. Uslu HY, Erkek AB, Cakmak A, et al. Trocar site hernia after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2007;17:600−3.

138. Garg P, Thakur JD, Garg M, et al. Single-incision laparoscopic cholecystectomy vs conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 2012;16:1618−28.

139. Trastulli S, Cirocchi R, Desiderio J, et al. Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg 2013;100:191−208.

140. Milas M, Deveđija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: Up-dated systematic review and meta-analysis of randomized trials. Surgeon 2014;12:271−89.

141. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71−72.

142. van Ramshorst GH, Nieuwenhuizen J, Hop WC, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010;34:20−7.

143. van Ramshorst GH, Klop B, Hop WCJ, et al. Closure of midline laparotomies by means of small stitches: practical aspects of a new technique. Surg Technol Int 2013;23:34−8

144. Muysoms F, Campanelli G, Champault GG, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 2012;16:239−50.