The effects of two different surgical techniques used in fascia closure after liver surgeries performed with J incision on the development of incisional hernia

Introduction: The optimal closure of the fascia after liver resection has not been established. We aimed to compare the two fascia closure methods after liver resection: Layered (technique-1) versus mass (technique-2) running suture closure. Materials-Methods: 263 patients undergoing liver resection with j-shaped right subcostal incision were retrospectively evaluated. Layered closure was performed with polydioxanone (PDS) and polypropylene (corner suture) materials whereas mass closure was performed with PDS. The preoperative, intraoperative parameters and postoperative wound complications were compared. Results: There were 144 patients in technique-1 and 119 patients in technique-2, which was similar in age, gender and body weight distribution. Comorbid conditions and malignancy rate were high in technique-2 group whereas total operation time and intraoperative blood loss were significantly decreased (p<0.001 and p=0.004). High surgical site infection rates (p=0.008) and complicated postoperative course were remarkable in technique-2 group. The median lengths of follow-up for incisional hernia (İH) were 67 (range, 25-147) months and 36 (range, 19-71) months in the technique-1 group and technique-2 group, respectively. The incidence of İH decreased from 24.3% (technique-1) to 15.1% (technique-2) (p=0.065). Presence of malignancy was identified as an independent risk factor for İH and it was associated with 2.03-fold higher risk for development of İH after hepatic resection (95% confidence interval; 1.06 – 3.9). Conclusion: Mass running suture with PDS seemed to be more timesaving in incision closure and effective in wound healing. Keywords: Liver resection, incisional hernia, j-shaped right subcostal incision