Research Article| Volume 60, ISSUE 4, P389-392, April 2007

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Inverting bilateral figure-of-eight suture of the rectus sheath after burst abdomen with destruction of the linea alba: A new technique

Published:January 22, 2007DOI:


      The authors report a new technique for secondary abdominal closure after burst abdomen as illustrated by the case of a patient who developed a perforated sigmoid diverticulitis following septic polyarthritis. Sigmoid resection was followed on the sixth day postoperative by a burst abdomen. Upon abdominal revision the burst abdomen was found to be caused by necrotic destruction of the linea alba. Abdominal wall closure was achieved using the novel technique of inverting bilateral interrupted figure-of-eight suture of the anterior and posterior rectus sheaths in combination with relieving lateral incisions and mesh implantation in the sublay technique. It remains for future studies to show whether this technique can reduce the high incisional hernia rate following secondary abdominal wall closure.


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        • Fleischer G.M.
        • Rennert A.
        • Rühmer M.
        Die infizierte Bauchdecke und der Platzbauch.
        Chirurg. 2000; 71: 754-762
        • Fackelday V.
        • Höer J.
        • Klinge U.
        Faszienheilungsmöglichkeiten und Platzbauch.
        Chirurg. 2004; 755: 477-483
        • Campbell J.A.
        • Temple W.J.
        • Frank C.B.
        • et al.
        A biomechanical study of suture pullout in linea alba.
        Surgery. 1989; 106: 888-892
        • Rout W.R.
        Abdominal incisions.
        in: Zuidema G.D. Yeo C.J. 5th ed. Shackelford's surgery of the alimentary tract. vol. II. WB Sounders Co, Philadelphia2002: 296
        • Poole G.V.
        Mechanical factors in abdominal wound closure: the prevention of fascial dehiscence.
        Surgery. 1985; 97: 631-639
        • Jenkins T.P.
        The burst abdominal wound: a mechanical approach.
        Br J Surg. 1976; 63: 873-876
        • Stelzner F.
        Theorie und Praxis der fortlaufenden Laparotomienaht (Platzbauch und Narbenhernie).
        Chirurg. 1988; 59: 654-660
        • Axer H.
        • Graf V.
        • Keyserlingk D.
        • et al.
        Collagen fibers in Linea alba and rectus sheaths. II – variability and biomechanical aspects.
        J Surg Res. 2001; 96: 239-245
        • Axer H.
        • Graf V.
        • Keyserlingk D.
        • et al.
        Collagen fibers in linea alba and rectus sheaths. I – General scheme and morphological aspects.
        J Surg Res. 2001; 96: 127-134
        • Grace R.H.
        • Cox S.
        Incidence of incisional hernia after dehiscence of the abdominal wound.
        Am J Surg. 1976; 131: 210-212
        • Gislason H.
        • Viste A.
        Closure of burst abdomen after major gastrointestinal operations – comparison of different surgical techniques and later development of incisional hernia.
        Eur J Surg. 1999; 165: 958-961
        • Howdieshell T.R.
        • Proctor C.D.
        • Sternberg E.S.
        • et al.
        Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen.
        Am J Surg. 2004; 188: 301-306
        • Shestak K.C.
        • Edington H.J.D.
        • Johnson R.R.
        The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited.
        Plast Reconstr Surg. 2000; 105: 731-738
        • Ramirez O.M.
        • Ruas E.
        • Dellon A.L.
        ‘Component separation’ method for closure of abdominal-wall defects: an anatomic and clinical study.
        Plast Reconstr Surg. 1990; 86: 519-526
        • Johnson D.
        • Harrison D.H.
        A technique for repairing massive ventral incisional hernias without the use of a mesh.
        Br J Plast Surg. 1999; 52: 399-403
        • Birolini C.
        • Utiyama E.M.
        • Rodrigues Jr., A.J.
        • et al.
        Elective colonic operation and prosthetic repair of incisional hernias: does contamination contraindicate abdominal wall prosthesis use?.
        J Am Coll Surg. 2000; 191: 366-372