Equipment

Equipment required for abdominal closure includes the following:

Suture
Staples
Kocher clamps
Malleable retractor
Adhesive tape
Synthetic glue

Suture selection is highly physician-dependent. Potential advantages and disadvantages are inherent with each particular suture. Suture can be chosen on the basis of tensile strength, longevity, and size. For abdominal closures, significant benefit has been shown for the use of nonabsorbable or delayed-absorbable suture.

Nonabsorbable suture is a prominent choice because it retains its tensile strength; however, it has been reported to yield increased incisional pain.^[8]This has led many surgeons to opt for delayed-absorbable suture, which can retain its original tensile strength for some time and has been reported to yield decreased suture pain.^{[9, 4]}The suture length should be at least four times the length of the incision, ensuring that enough suture is available for adequate bites of fascia and that the stitches are not placed too far apart.^{[5, 3]}

Patient Preparation

Patients should be under general anesthesia. They are generally positioned supine; however, in some instances, it may be important to position them laterally.

Technique

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Media Gallery

Abdominal anatomic landmarks.
Layers of abdomen, from interior to exterior: peritoneum, extraperitoneal fascia, muscle, deep fascia, superficial fascia, subcutaneous tissue, and skin.
Midline incision.
(A) Fascial closure. (B) Looping of 0 polydioxanone (PDS) at vertex. (C) Continuous suture. (D) Two PDS ends meeting in middle of incision, tied together, and cut.
Paramedian incision.
Transverse incision.
Kocher subcostal incision.
Rockey-Davis muscle-splitting incision.
Pfannenstiel incision.
Epidermis, dermis, and subcutis, showing hair follicle, sweat gland, and sebaceous gland. Image courtesy of Wikimedia Commons.

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Author

Luis G Fernández, MD, KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS Professor of Surgery, Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center; Clinical Assistant Professor of Surgery, Department of Surgery, University of Texas Medical Branch; Adjunct Clinical Professor of Medicine and Nursing, University of Texas; Adjunct Clinical Assistant Professor, Department of Medical Education Health Science Center, Adjunct Clinical Assistant Professor, Department of Physician Assistant Studies, School of Health Professions, University of North Texas; Medical Director, Trauma Wound Care, UT Health East; Member, ACS National Committee on Trauma; Vice Chairman, State Guard Association of the United States (SGAUS) Medical Academy; Commander Emeritus, Texas Commandery, MOFW; Brigadier General (Ret/HR), Past Commanding General, TXSG Medical Brigade/Medical Rangers

Luis G Fernández, MD, KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Legal Medicine, American College of Surgeons, American Society of Abdominal Surgeons, American Society of General Surgeons, American Society of Law, Medicine & Ethics, American Trauma Society, Association for Surgical Education, Association of Military Surgeons of the US, Chicago Medical Society, Illinois State Medical Society, International College of Surgeons, New York Academy of Sciences, Pan-American Trauma Society, Society of Critical Care Medicine, Society of Laparoscopic and Robotic Surgeons, Southeastern Surgical Congress, Texas Medical Association, Undersea and Hyperbaric Medical Society

Disclosure: Received honoraria from KCI for speaking and teaching; Received honoraria from PACIRA for speaking and teaching; Speaker / teaching honoraria for URGO -Stedmed North America.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Associate Professor, Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine; Chair, Department of Surgery, Saint Francis Hospital, Trinity Health of New England Medical Group

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Abdominal Closure Periprocedural Care

Equipment

Patient Preparation

References

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