Miller Benjamin T, Ellis Ryan C, Walsh R Matthew, Joyce Daniel, Simon Robert, Almassi Nima, Lee Byron, DeBernardo Robert, Steele Scott, Haywood Samuel, Beffa Lindsey, Tu Chao, Rosen Michael J
Center for Abdominal Core Health, Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-429, Cleveland, OH, 44195, USA.
Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Surg Endosc. 2023 Dec;37(12):9347-9350. doi: 10.1007/s00464-023-10346-w. Epub 2023 Aug 28.
Tension-free abdominal closure is a primary tenet of laparotomy. But this concept neglects the baseline tension of the abdominal wall. Ideally, abdominal closure should be tailored to restore native physiologic tension. We sought to quantify the tension needed to re-establish the linea alba in patients undergoing exploratory laparotomy.
Patients without ventral hernias undergoing laparotomy at a single institution were enrolled from December 2021 to September 2022. Patients who had undergone prior laparotomy were included. Exclusion criteria included prior incisional hernia repair, presence of an ostomy, large-volume ascites, and large intra-abdominal tumors. After laparotomy, a sterilizable tensiometer measured the quantitative tension needed to bring the fascial edge to the midline. Outcomes included the force needed to bring the fascial edge to the midline and the association of BMI, incision length, and prior lateral incisions on abdominal wall tension.
This study included 86 patients, for a total of 172 measurements (right and left for each patient). Median patient BMI was 26.4 kg/m (IQR 22.9;31.5), and median incision length was 17.0 cm (IQR 14;20). Mean tension needed to bring the myofascial edge to the midline was 0.97 lbs. (SD 1.03). Mixed-effect multivariable regression modeling found that increasing BMI and greater incision length were associated with higher abdominal wall tension (coefficient 0.04, 95% CI [0.01,0.07]; p = 0.004, coefficient 0.04, 95% CI [0.01,0.07]; p = 0.006, respectively).
In patients undergoing laparotomy, the tension needed to re-establish the linea alba is approximately 1.94 lbs. A quantitative understanding of baseline abdominal wall tension may help surgeons tailor abdominal closure in complex scenarios, including ventral hernia repairs and open or burst abdomens.
无张力腹壁缝合是剖腹手术的一项基本原则。但这一概念忽略了腹壁的基线张力。理想情况下，腹壁缝合应根据恢复天然生理张力进行调整。我们试图量化接受剖腹探查术患者重建白线所需的张力。
2021年12月至2022年9月，纳入在单一机构接受剖腹手术且无腹疝的患者。包括曾接受过剖腹手术的患者。排除标准包括既往切口疝修补术、造口存在、大量腹水和巨大腹腔内肿瘤。剖腹手术后，使用可消毒的张力计测量将筋膜边缘拉至中线所需的定量张力。结果包括将筋膜边缘拉至中线所需的力以及体重指数、切口长度和既往侧方切口与腹壁张力的关联。
本研究纳入86例患者，共进行172次测量（每位患者左右两侧各测量一次）。患者体重指数中位数为26.4kg/m（四分位间距22.9；31.5），切口长度中位数为17.0cm（四分位间距14；20）。将肌筋膜边缘拉至中线所需的平均张力为0.97磅（标准差1.03）。混合效应多变量回归模型发现，体重指数增加和切口长度增加与腹壁张力升高相关（系数分别为0.04，95%置信区间[0.01,0.07]；p = 0.004，系数0.04，95%置信区间[0.01,0.07]；p = 0.006）。
在接受剖腹手术的患者中，重建白线所需的张力约为1.94磅。对腹壁基线张力的定量了解可能有助于外科医生在复杂情况下调整腹壁缝合，包括腹疝修补术以及开放性或破裂性腹部手术。
