Conclusions from the follow-up of the most recent ECLAPTES recommendations about laparotomy closure procedures. Outcomes of an assessment
Authors: Saad Hassan A. Saad , Farid Mohamed I , Baz Azza , Riad Mohamed , Eraky Mohamed E , Sharaf Kahed 
Published: October 2023

Abstract
Following emergency laparotomy, incisional hernias are associated with considerable morbidity and high expenses. According to recent research on the prevention of incisional hernia formation, a laparotomy closure technique with a slowly absorbable monofilament suture with small fascial steps and bites in a continuous single layer with a suture length to wound length (SL/WL) ratio of at least 4:1. The applicability of this evidence to routine practice is not well understood. Thus, a survey of surgeons at Zagazig University Hospital was conducted.
Methods
We have added the frame of Effective Closure of LAParotomy in (ECLAPTE) stands for Incisional Hernia (IHs) and followed it in my work to attain suitable and better outcomes. Fewer data are available on laparotomy closure in emergency situations, and guidelines and indications from earlier research have only been applied to elective cases. This work introduces the ECLAPTE project, which is currently being conducted by the World Society of Emergency Surgery (WSES). An online survey including 24 questions was distributed to all members of Our Surgical Society regarding the methods and supplies utilized for abdominal wall closure following midline laparotomy. The ECLAPTE guideline described perfect closure after laparotomy, so we used that recommendation for dissemination. Subgroup analysis was performed according to experience, hospital type, and surgical specialization.
Results
Of 402 responses, or 26% of the total, 97% of the Zagazig University Hospital Surgical Departments were represented. After following the ECLAPTE recommendation for our surgery, almost 90% of the participants used a slowly absorbable monofilament running suture to seal the abdominal wall in a single mass layer. Only 35% of the participants adhered to an SL/WL ratio of >4:1, and participant preference for suture size varied. Although the risk factors for the formation of incisional hernias were mostly properly identified, more than half of the participants were ignorant of the frequency and timing of incisional hernia occurrence. Based on a subgroup study, surgeons specializing in gastrointestinal and oncological procedures favored sutures with a smaller diameter and a higher ratio of suture length to wound length. Compared with other subspecialties, trauma, vascular, and pediatric surgeons have reported a reduced incidence of incisional hernias. Compared to their counterparts in non-academic institutions, surgeons working at academic hospitals were more likely to utilize smaller suture sizes and fascial steps. Estimations of incisional hernia incidence are less accurate when surgeons perform fewer than 10 laparotomies per year.
conclusions
It is not common practice to apply the most recent research to abdominal wall closure procedures. The most recent data recommend a 4:1 ratio of suture length to wound length; however, only 35 percent of surgeons use this technique to seal the abdominal fascia. Patients with IH are associated with a detectable rate of bulge perception, but with following ECLAPTE (Effective Closure of LAParoTomy in Emergency (ECLAPTE) initiative decreases the need for emergency laparotomy because of decreased recurrence and bulge complications with improved quality of life and postoperative pain. Preoperative cases must be discussed before making an ideal decision and increasing dissemination of the technique.