Effect of stapled versus layered skin closure on surgical site occurrences after abdominal wall reconstruction

Bryana Baginski; Regan Van Metre; Quinn Elliott; Jeremy A Warren; J Alex Ewing; William S Cobb; Alfredo M Carbonell

doi:10.1007/s00464-022-09260-4

Effect of stapled versus layered skin closure on surgical site occurrences after abdominal wall reconstruction

Surg Endosc. 2022 Dec;36(12):9403-9409. doi: 10.1007/s00464-022-09260-4. Epub 2022 May 12.

Authors

Bryana Baginski¹, Regan Van Metre², Quinn Elliott³, Jeremy A Warren⁴, J Alex Ewing⁵, William S Cobb⁴, Alfredo M Carbonell⁶

Affiliations

¹ Baylor University Medical Center, Dallas, TX, USA.
² University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
³ Furman University, Greenville, SC, USA.
⁴ Department of Surgery, Prisma Health-Upstate, 701 Grove Rd, Greenville, SC, 29605, USA.
⁵ Office of Research Administration, Prisma Health-Upstate, Greenville, SC, USA.
⁶ Department of Surgery, Prisma Health-Upstate, 701 Grove Rd, Greenville, SC, 29605, USA. Alfredo.carbonell@prismahealth.org.

PMID: 35556167
DOI: 10.1007/s00464-022-09260-4

Abstract

Background: The effect of skin closure technique on surgical site occurrences (SSO) after open abdominal wall reconstruction (AWR) with retromuscular polypropylene mesh placement is largely unknown. We hypothesize that layered subcuticular skin closure with cyanoacrylate skin adhesive is protective of surgical site infection compared to standard stapled closure.

Methods: A retrospective review utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database of all patients at Prisma Health-Upstate. All patients with open abdominal wall reconstruction (AWR) of midline incisional hernia defects with retromuscular polypropylene mesh placement from January 2013 to February 2020 were included. Patient demographics, comorbidities, type of hernia repair with mesh location, method of skin closure, and SSOs were collected. Skin closure method was divided into two groups, reflecting a temporal change in practice: staples (historical control group) versus subcuticular suture with cyanoacrylate skin adhesive with/without polymer mesh tape (study group). Primary endpoint was SSI and SSO. Secondary endpoints were SSO or SSI requiring procedural intervention (SSOPI/SSIPI). Standard statistical methods were utilized.

Results: A total of 834 patients were analyzed, with 263 treated with stapled skin closure and 571 with subcuticular and adhesive closure. On univariate analysis, the incidence of SSI was significantly lower in the study group (11.8 vs 6.8%; p = 0.002), as was the need for SSIPI (11.8 vs 6.7%; p = 0.015). Rate of SSO was not significantly different between groups (28.1 vs 27.2%), but the rate of SSO requiring intervention was lower in the study group (14.1 vs 9.3%; p = 0.045).

Conclusion: Layered skin closure technique, including subcuticular closure and adhesive, may reduce the risk of surgical site infection after open AWR. A prospective randomized trial is planned to confirm these findings.

Keywords: Abdominal wall reconstruction; Retromuscular mesh placement; Surgical site infections; Surgical site occurrences; Ventral hernia repair.

MeSH terms

Abdominal Wall* / surgery
Abdominal Wound Closure Techniques* / adverse effects
Cyanoacrylates / therapeutic use
Hernia, Ventral* / complications
Herniorrhaphy / methods
Humans
Polypropylenes
Prospective Studies
Retrospective Studies
Surgical Mesh / adverse effects
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Surgical Wound Infection / prevention & control

Substances

Polypropylenes
Cyanoacrylates