Complex abdominal wall reconstruction

The aim of this thesis was to improve outcomes of open complex abdominal wall reconstruction. In the first part we discuss different variables that complicate these procedures and provide evidence based options for preoperative optimization. This includes the preoperative intramuscular injection of botulinum toxin, and the addition of a long acting somatostatin analogue to standard care to reduce intestinal output in patients with a high-output fistula or enterostomy. In the second part we investigate the effectiveness of the use of antibiotic-coated sutures for wound closure to reduce the risk of acute abdominal wall dehiscence. Also, we investigate three different type of (partly) resorbable biosynthetic meshes used in highly complex repairs.