5 Takeaways From European Hernia Society 45th Annual Congress

The European Hernia Society (EHS) up its annual congress last week and it was
filled with education, research, new technologies and latest evidence.
EHS is a non-profit association uniting professionals, industry and patients
interested in the repair of abdominal wall defects, hernias, and other problems
related to the abdominal wall.

Many sessions focused on incisional hernia prevention and many speakers
highlighted implementation of the correct closure technique in midline
laparotomy.

We at Suturion are also thrilled that the 2022 updated joint guidelines from
European and American Hernia Societies on incisional hernia prevention, was
mentioned and discussed throughout the congress.
The guidelines advice surgeons on preventive actions for reduction of incisional
hernia and recommends the small bites technique. You can access the guidelines
here.

1. Implementation is difficult.

Benjamin Poulose (US) talked about the importance of prevention and the
difficulties to re-train surgeons. Reimbursement is a hurdle as different health
providers perform the index operation and the incisional hernia repair procedure.
Hospital administration must be involved to make a business case to
accommodate devices for prevention.
Liver surgeon Frederik Berrevoet (BE) stated that implementation must start with
young trainees and surgeons with genuine interest: train the young is more
effective than changing the old.

2. Correct closure of the midline laparotomy.
Jose Antonio Pereira (SP) stated that all closures in midline laparotomy should be
performed with small bites technique. Laparotomy is a high-risk procedure, even
in low-risk patients, and prevention should be applied in all patients.

3. Double important, correct opening and correct closing in midline laparotomy.

Rene Fortelny (AT) presented the ESTOIH RCT 1 which compared laparotomy
related abdominal wall complications between small and large bites using the
BBRAUN Monomax suture. He stated important preventive measures include
correct opening and correct closing of the midline. The suture line shall be
without tension to avoid ischemia and it is important to start the incision at the
button where there is a small natural orifice to avoid exposing the rectus muscle.
ESTOIH trial showed 7-fold increase in burst abdomen if long stitches where
used. Both wound infections and incisional hernia formation at one year was
reduced with small stitches but did not reach significance. Estoih trial adds more
evidence to support small bites technique.

4.The correct closure in non-midline laparotomy.

Hobart Harris (US) advocated that even though the recommendations for using
small bites in midline laparotomy are weak, we should apply the same
meticulous closure principles in non-midline principles to reduce complications.
The importance of a tension free suture line excluding muscle and fatty tissue
from the suture line to avoid ischemia is equally important in non-midline incision
closures.

“The current scientific foundation and evidence for what measures that shall be
taken to reduce complications and guidelines that state that the small bites
technique is the preferred strategy for closing a laparotomy wound is getting is
on the agenda. We are in a stronger position to communicate the importance of
the small bites technique and how our device can help the surgeons to adhere to
the guidelines” says Gabriel Börner, MD. Founder and Chief Medical Officer at
Suturion.

¹ https://academic.oup.com/bjs/article/109/9/839/6609058

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