Background: After median laparotomy, excessive horizontal tensile forces on the suture base or scar tissue lead to incisional hernias or recurrent hernias. Our new suture technique, known as reinforced tension line (RTL), allows peak tensile forces to be distributed from the suture base to the surrounding tissue through a longitudinal suture, thereby preventing the suture from cutting through the tissue.
Methods: From April 2002 to April 2005, the RTL technique was used to treat 103 patients with ventral abdominal wall hernias > or = 3 cm in size. In patients with larger hernias, tensile forces were measured intraoperatively. Patients with tensions > or = 40 N during fascial closure were excluded from the study. Comorbidities, as well as intraoperative and postoperative complications, were recorded. Early and late complications were monitored during a follow-up period of 12 to 48 months.
Results: Tensile loads > or = 40 N in the fascia were recorded in 7 of 103 patients. The 7 patients were treated with mesh prostheses and excluded from the study. The mean age of the remaining 96 patients was 64 years, and the mean size of the hernial orifice was 58 cm2 (range 7-211 cm2). Twenty-eight patients with hernias underwent acute surgery. No intraoperative complications were encountered. After surgery, 5 patients developed hematomas that did not require revision surgery. Five asymptomatic recurrences (5.5%) were diagnosed during a mean follow-up period of 32 months.
Conclusions: The use of RTL allows the loads impinging on the suture base to be distributed over the surrounding tissue. Rupture of the thread from the suture base is prevented, and abdominal wall hernias can be treated effectively. Particularly in cases of acute surgery or contamination of the surgical area, or in the presence of other contraindications for using mesh, the RTL technique is an excellent alternative to mesh repair. These favorable preliminary results must be evaluated in further investigations.