TENSIOMETRY AS A THERAPEUTIC AID IN ABDOMINAL WALL RECONSTRUCTION WITH COMPONENT SEPARATION

We must take into account that there are two relevant factors involved in the recurrence rate of an incisional hernia: the surgical technique and the tension applied to the suture line. Minimizing as much as possible the tension resulting at the suture line is the main objective through an anatomical reconstruction of the defect, although in recent years it seems that non-anatomical repair (laparoscopy) is playing an important role in improving abdominal wall function recovery. Ramirez et al. described an anatomical abdominal wall reconstruction technique called component separation, in which the goal is essentially to “gain territory” over the midline defect. Two incisions are made on each side: one in the medial aspect of the anterior rectus sheath along its longitudinal axis to create a flap toward the midline; and another longitudinal incision at the junction of the external oblique fascia with the rectus abdominis, allowing separation of both muscles while leaving the fascia of the internal oblique and transversus abdominis underneath. An incisional hernia should be repaired except in some patient-specific conditions. The question of whether anatomical or non-anatomical repair should be performed remains controversial. In any case, sutures in the abdominal wall should not be subjected to excessive tension, as the recurrence rate increases regardless of the technique used (Shestak KC, 2000). Therefore, it is important to consider the tension applied to the suture line. Klein P. et al. used a method to measure midline tension with conventional dynamometers and highlighted the importance of knowing threshold values to decide whether reinforcement of the suture line is required. In their studies, Klein observed that when tension exceeded 14.5 N (1.5 kp), component separation was recommended, and if high tension persisted, mesh reinforcement should be used. Another relevant finding was that tensions >34.3 N (3.5 kp) could lead to abdominal compartment syndrome. Therefore, measuring tension during abdominal wall closure may play an important role in better controlling the incidence and recurrence of incisional hernias.