2026; 9(2): 1-6
DOI: 10.32114/CCI.2026.9.2.1.6
Published online: 2026-06-30 (first online 2026-05-29)
Mechanical stress and geometry of fascial closure in critically ill patients after laparotomy.
Michał Romańczuk [1]
,
Kryspin Mitura [1,2] .
[1] Department of General Surgery, Siedlce Hospital, Poland, Siedlce
[2] Faculty of Medical and Health Sciences, University in Siedlce, Poland, Siedlce
Abstract:
Abstract [EN] -
Wound dehiscence after laparotomy remains a severe and potentially life-threatening complication, particularly in critically ill patients exposed to increased intra-abdominal pressure, mechanical ventilation, and repetitive mechanical stress. Traditionally, fascial failure has been attributed primarily to impaired biological healing; however, this perspective does not fully explain the dynamic mechanical environment of the abdominal wall in the postoperative period. This review proposes a unified mechanical and geometric framework for understanding fascial failure after laparotomy. It emphasizes that successful closure depends not only on tissue quality but also on the distribution of forces and the geometry of the fascial defect. Intraoperative techniques such as progressive suturing and central force redistribution partially address this problem by modifying defect geometry and reducing peak tension. However, these strategies do not extend into the postoperative phase, where critically ill patients are exposed to repeated dynamic loading. This mismatch between tissue strength and mechanical stress may lead to progressive suture failure and wound dehiscence. Understanding fascial closure as a dynamic system influenced by both mechanical forces and geometric configuration may provide new insights into the prevention of postoperative complications and guide the development of future therapeutic strategies.
Streszczenie [PL] -
Rozejście się rany po laparotomii pozostaje poważnym i potencjalnie zagrażającym życiu powikłaniem, szczególnie u pacjentów w stanie krytycznym narażonych na zwiększone ciśnienie wewnątrzbrzuszne, wentylację mechaniczną i powtarzające się obciążenia mechaniczne. Tradycyjnie, uszkodzenie powięzi przypisywano głównie zaburzeniom gojenia biologicznego; jednakże ta perspektywa nie wyjaśnia w pełni dynamicznego środowiska mechanicznego ściany brzucha w okresie pooperacyjnym. Niniejszy przegląd proponuje ujednolicone ramy mechaniczne i geometryczne dla zrozumienia uszkodzenia powięzi po laparotomii. Podkreśla się, że skuteczne zamknięcie rany zależy nie tylko od jakości tkanek, ale także od rozkładu sił i geometrii ubytku powięzi. Techniki śródoperacyjne, takie jak progresywne szycie i centralna redystrybucja sił, częściowo rozwiązują ten problem poprzez modyfikację geometrii ubytku i zmniejszenie szczytowego napięcia. Strategie te nie mają jednak zastosowania w fazie pooperacyjnej, w której pacjenci w stanie krytycznym są narażeni na powtarzające się obciążenia dynamiczne. Ta dysproporcja między wytrzymałością tkanek a obciążeniem mechanicznym może prowadzić do postępującego rozejście się szwów i rozejścia się rany. Zrozumienie procesu zamykania powięzi jako dynamicznego systemu, na który wpływają zarówno siły mechaniczne, jak i konfiguracja geometryczna, może dostarczyć nowych spostrzeżeń na temat zapobiegania powikłaniom pooperacyjnym i ukierunkować rozwój przyszłych strategii terapeutycznych.
Citation:
VANCOUVER FORMAT
Romańczuk M, Mitura K. Mechanical stress and geometry of fascial closure in critically ill patients after laparotomy.
Crit Care Innov. 2026; 9(2): 1-6.
DOI: 10.32114/CCI.2026.9.2.1.6
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References:
| [1] |
Martínez-López P, Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Pereira JA, Hernández-Granados P, López-
Cano M, et al. Lateralincisional hernia. EVEREG registry analysis. Hernia. 2024; 28(5): 1769-1774.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [2] |
Hernández-Villafranca S, Qian-Zhang S, Silla IO, de Molina Rampérez MLS, Alises EC, Sánchez C, et al. Extended
totallyextraperitoneal (eTEP) treatment for lateralprimary and incisionalhernias. New approach to oldproblems.
Hernia. 2022; 26(6): 1541-1549.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [3] |
Guo AA, Isaac D, Jaraczewski L, Cobb WS, Carbonell AM, Warren JA. Roboticrepair of non-midlinehernias. J Robot
Surg. 2023; 17(3): 1021-1027.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [4] |
Ferrarese A, Enrico S, Solej M, Surace A, Junior Nardi M, Millo P, et al. Laparoscopic management of non-midline
incisional hernia: A multicentric study. Int J Surg. 2016; 33 Suppl1: S108-S113.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [5] |
Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, et al. Erratum to: Updated
guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg.
2023; 110(2): 287.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [6] |
Michot N, Ortega-Deballon P, Karam E, Pabst-Giger U, Ouaissi M. Is There a Clinical Benefit of Abdominal Binders
After Abdominal Surgery: A Systematic Literature Review. J Abdom Wall Surg. 2024; 3: 13506.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [7] |
Bouvier A, Rat P, Drissi-Chbihi F, Bonnetain F, Lacaine F, Mariette C, et al. Abdominal binders after laparotomy:
review of the literature and French survey of policies. Hernia. 18(4): 501-506.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [8] |
Ormseth BH, Livermore NR, Schoenbrunner AR, Janis JE. The Use of Postoperative Compression Garments in
Plastic Surgery-Necessary or Not? A Practical Review. Plast Reconstr Surg Glob Open. 2023; 11(9): e5293.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [9] |
Khalid IB, Babar M, Ahmed I. Post-operative Use of Abdominal Binders: Bound to Tradition? J Cancer Allied Spec.
2022; 8(2): 463.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [10] |
Skolimowska-Rzewuska M, Mitura K. Essential anatomical landmarks in placement of anadequate size mesh for a
successful ventral hernia repair. Pol PrzeglChir. 2021; 93(5): 1-5.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [11] |
Kushner BS, Arefanian S, McAllister J, Hui Tan W, Grant M, MacGregor R, et al. Examination of abdominal wall
perfusion using varying suture techniques for midline abdominal laparotomy closure. Surg Endosc. 2022; 36(6):
3843-3851.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [12] |
Lesch C, Uhr K, Vollmer M, Raschidi R, Nessel R, Kallinowski F. Standardized suturing can prevent slackening or
bursting suture lines in midline abdominal incisions and defects. Hernia. 2022; 26(6): 1611-1623.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [13] |
Cornette B, De Bacquer D, Berrevoet F. Component separation technique for giant incisional hernia: A systematic
review. Am J Surg. 2018; 215(4): 719-726.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [14] |
Paasch C, Santo G, Aljedani N, Ortiz P, Bruckert L, Hünerbein M, et al. The Effect of an Abdominal Binder on
Postoperative Pain After Laparoscopic Incisional Hernia Repair–A Multicenter, Randomized Pilot Trial (ABIHR-I) of
the Intraperitoneal Onlay-Mesh Technique. Dtsch Arztebl Int. 2021; 118(37): 607-613.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [15] |
Ortiz PR, Lorenz E, Meyer F, Croner R, Lünse S, Hunger R, et al. The effect of an abdominal binder on
postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial
(ABIHR-II). Hernia. 2023; 27(5): 1263-1271.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [16] |
Christoffersen MW, Olsen BH, Rosenberg J, Bisgaard T. Randomized clinical trial on the postoperative use of an
abdominal binder after laparoscopic umbilical and epigastric hernia repair. Hernia. 2015; 19(1): 147-153.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [17] |
Zia MK, Sehrish Y, Abbasi F, Bano S, Nehal Z, Qureshi A. Comparison of abdominal binder use versus no
abdominal binder use after ventral abdominal wall hernia repair. Pak J Med Health Sci 2021; 15: 720–723.
| Scholar Google | |
| [18] |
Graziani E Sousa A, Prajiante Bertolino E, Godoi A, Florêncio de Mesquita C, Canizares Quisiguina SI, Mazzola
Poli de Figueiredo S. Effect of an abdominal binder on postoperative outcomes after ventral he
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [19] |
Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Bergeret C, al. Midline incisional hernia guidelines:
European Hernia Society. Br J Surg. 2023; 110(12): 1732–1768.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [20] |
Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW. Outcomes of laparoscopic ventral hernia repair
with routine defect closure using "shoelacing" technique. Surg Endosc. 2011; 25(5): 1452-1457.
| Digital Object Identifier (DOI) | Scholar Google | |
| [21] |
Nguyen D, Szomstein S, Ordonez A, Dip F, Rajan M, Lo Menzo E, et al. Unidirectional barbed sutures as a novel
technique for laparoscopic ventral hernia repair. Surg Endosc. 2016; 30(2): 764-769.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [22] |
Bell-Allen N, Swift K, Sontag NJ, O'Rourke N. Ventral hernia repair with a hybrid laparoscopic technique. ANZ J
Surg. 2022; 92(10): 2529-2533
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [23] |
Stoikes N, Quasebarth M, Brunt LM. Hybrid ventral hernia repair: technique and results. Hernia. 2013; 17(5): 627-
632.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |
| [24] |
Mikami DJ, Melvin WS, Murayama MJ, Murayama KM. Impact of minimally invasive surgery on healthcare
utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH). Surg Endosc. 2017;
31(11): 4412-4418.
| Digital Object Identifier (DOI) | PubMed (NCBI) | Scholar Google | |