PDF(Pubmed)
Abstract：
BACKGROUND: One of the primary complications associated with large incisions in abdominal surgery is the increased risk of fascial closure rupture and incisional hernia development. The choice of the fascial closure method and closing with minimal tension and trauma is crucial for optimal results, emphasizing the importance of uniform pressure along the suture line to withstand intra-abdominal pressure.
OBJECTIVE: To evaluate the resistance to pressure and tension of stapled and sutured hand-sewn fascial closure in the abdominal wall.
METHODS: Nine abdominal wall flaps from human cadavers and 12 pigs were used for the experimentation. An abdominal defect was induced after the resection of the abdominal wall and the creation of a flap in the cadaveric model and after performing a midline incision in the porcine models. The models were randomized into three groups. Group 1 was treated with a one-layer hand-sewn small bite suture, Group 2 was treated with a two-layer hand-sewn small bite suture, and Group 3 was treated with a two-layer stapled closure. Tension measurements were assessed in cadaveric models, and intra-abdominal pressure was measured in porcine models.
RESULTS: In the human cadaveric model, the median threshold for fascial rupture was 300N (300-350) in Group 1, 400N (350-500) in Group 2, and 350N (300-380) in Group 3. Statistical comparisons revealed non-significant differences between Group 1 and Group 2 (p=0.072, p>0.05), Group 1 and Group 3 (p=0.346, p>0.05), and Group 2 and Group 3 (p=0.184, p>0.05). For porcine subjects, Group 1 showed a median pressure of 80 mmHg (85-105), Group 2 had a median of 92.5 mmHg (65-95), and Group 3 had a median of 102.5 mmHg (80-135). Statistical comparisons indicated non-significant differences between Group 1 and Group 2 (p=0.243, p>0.05), Group 1 and Group 3 (p=0.468, p>0.05), and Group 2 and Group 3 (p=0.083, p>0.05).
CONCLUSIONS: Stapled and conventional suturing resist similar pressure and tension thresholds.
OBJECTIVE: To evaluate the resistance to pressure and tension of stapled and sutured hand-sewn fascial closure in the abdominal wall.
METHODS: Nine abdominal wall flaps from human cadavers and 12 pigs were used for the experimentation. An abdominal defect was induced after the resection of the abdominal wall and the creation of a flap in the cadaveric model and after performing a midline incision in the porcine models. The models were randomized into three groups. Group 1 was treated with a one-layer hand-sewn small bite suture, Group 2 was treated with a two-layer hand-sewn small bite suture, and Group 3 was treated with a two-layer stapled closure. Tension measurements were assessed in cadaveric models, and intra-abdominal pressure was measured in porcine models.
RESULTS: In the human cadaveric model, the median threshold for fascial rupture was 300N (300-350) in Group 1, 400N (350-500) in Group 2, and 350N (300-380) in Group 3. Statistical comparisons revealed non-significant differences between Group 1 and Group 2 (p=0.072, p>0.05), Group 1 and Group 3 (p=0.346, p>0.05), and Group 2 and Group 3 (p=0.184, p>0.05). For porcine subjects, Group 1 showed a median pressure of 80 mmHg (85-105), Group 2 had a median of 92.5 mmHg (65-95), and Group 3 had a median of 102.5 mmHg (80-135). Statistical comparisons indicated non-significant differences between Group 1 and Group 2 (p=0.243, p>0.05), Group 1 and Group 3 (p=0.468, p>0.05), and Group 2 and Group 3 (p=0.083, p>0.05).
CONCLUSIONS: Stapled and conventional suturing resist similar pressure and tension thresholds.
摘要：
背景：腹部手术中与大切口相关的主要并发症之一是筋膜闭合破裂和切口疝发展的风险增加。筋膜闭合方法的选择和以最小的张力和创伤闭合对于最佳结果至关重要，强调沿着缝合线均匀压力以承受腹内压力的重要性。
目的：评估腹壁缝合和缝合的手工筋膜闭合对压力和张力的抵抗力。
方法:实验使用来自人尸体的9个腹壁皮瓣和12只猪。切除腹壁并在尸体模型中创建皮瓣后以及在猪模型中进行中线切口后，诱发了腹部缺损。将模型随机分为三组。第1组采用一层手工缝制的小咬合缝线治疗,第2组采用两层手工缝制小咬合缝线治疗，第3组采用两层缝合封口治疗。在尸体模型中评估张力测量值，在猪模型中测量腹内压。
结果：在人类尸体模型中，筋膜破裂的中位阈值在第1组中为300N(300-350),在第2组中为400N(350-500),在第3组中为350N(300-380).统计比较显示第1组和第2组之间无显著差异(p=0.072,p>0.05),第1组和第3组（p=0.346，p>0.05），以及组2和组3(p=0.184,p>0.05)。对于猪受试者，第1组显示中位压力为80mmHg（85-105），第2组的中位数为92.5mmHg（65-95），第3组的中位数为102.5mmHg（80-135）。统计学比较表明第1组和第2组之间无显著差异(p=0.243,p>0.05),第1组和第3组（p=0.468，p>0.05），以及组2和组3(p=0.083,p>0.05)。
结论：缝合和常规缝合抵抗相似的压力和张力阈值。
目的：评估腹壁缝合和缝合的手工筋膜闭合对压力和张力的抵抗力。
方法:实验使用来自人尸体的9个腹壁皮瓣和12只猪。切除腹壁并在尸体模型中创建皮瓣后以及在猪模型中进行中线切口后，诱发了腹部缺损。将模型随机分为三组。第1组采用一层手工缝制的小咬合缝线治疗,第2组采用两层手工缝制小咬合缝线治疗，第3组采用两层缝合封口治疗。在尸体模型中评估张力测量值，在猪模型中测量腹内压。
结果：在人类尸体模型中，筋膜破裂的中位阈值在第1组中为300N(300-350),在第2组中为400N(350-500),在第3组中为350N(300-380).统计比较显示第1组和第2组之间无显著差异(p=0.072,p>0.05),第1组和第3组（p=0.346，p>0.05），以及组2和组3(p=0.184,p>0.05)。对于猪受试者，第1组显示中位压力为80mmHg（85-105），第2组的中位数为92.5mmHg（65-95），第3组的中位数为102.5mmHg（80-135）。统计学比较表明第1组和第2组之间无显著差异(p=0.243,p>0.05),第1组和第3组（p=0.468，p>0.05），以及组2和组3(p=0.083,p>0.05)。
结论：缝合和常规缝合抵抗相似的压力和张力阈值。
