Anatomical and Mechanical Properties of Different Abdominal Wall Closure Methods: The New Dawn of the Mechanical Closure of the Abdominal Wall

Aim The closure of the abdominal wall remains one of the most debated issues in the field of hernia. Years ago we developed the usage of surgical staplers to perform this closure. That has the rationale of the small bites, with tension distribution and the usage of non-absorbable material. However, there is a question if the stapler could hold the tension of the abdominal wall compared with a standard suture. Hence, we developed a study to compare the anatomical and mechanical properties of both types of closure. Methods Using a validated model, 8 male pigs, weighing between 30 and 35 kg were randomized into two groups: 1) running suture using PDS 0 and 2) Stapler (4,5 mm). After the closure of the aponeurosis, gas was inflated into the peritoneal cavity until the evidence of friction of the aponeurosis and the tension in the wall was measured, as well as its elasticity. Comparisons were performed using the Mann-Whitney non-parametric test. Results The study showed that the resistance of a continuous suture was 93 mmHg, with a standard deviation of 8.54 mmHg. The closure of the aponeurosis with a stapler showed a result of 105 mmHg, with a standard deviation of 22.73 mmHg. There was no statistical difference (p = 0.083) between groups, showing non-inferiority of the stapler compared to the suture. Conclusion This study demonstrated that the stapled technique is viable compared to the standard type of closure. The non-inferior results shows that this technique may become an excellent option.