Abdominal Closure at Longitudinal and Horizontal Abdominal Incisions

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

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Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2014/784056 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Yu Chen ◽

Jinning Ye ◽

Wu Song ◽

Jianhui Chen ◽

Yujie Yuan ◽

...

Keyword(s):

Open Abdomen ◽

Meta Analysis ◽

Final Analysis ◽

Fascial Closure ◽

Cochrane Library ◽

Optimal Time ◽

Closure Rate ◽

Abdominal Closure ◽

Abdominal Fascia ◽

Delayed Closure

Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53,P<0.0001) and complication incidence (RR, 0.68,P<0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

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Reducing Morbidity in Urgent Gastroenterologic Surgery; Propensity Score Analysis Using Triclosan-Coated Polydioxanone Sutures

International Surgery ◽

10.9738/intsurg-d-17-00047.1 ◽

2017 ◽

Vol 102 (1-2) ◽

pp. 58-63

Author(s):

Shinsuke Takeno ◽

Kanefumi Yamashita ◽

Tomoaki Noritomi ◽

Seichiro Hoshino ◽

Yasushi Yamauchi ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Hospital Stay ◽

Propensity Score Matching ◽

Propensity Score Analysis ◽

Univariate Analysis ◽

Operation Time ◽

Surgical Site Infections ◽

Propensity Score Matching Analysis ◽

Abdominal Closure

Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P = 0.043); wound classification (P = 0.0005); peritonitis (P = 0.019); prolonged operation time (P = 0.0001); increased blood loss (P = 0.019); transfusion (P = 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P = 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P = 0.20), but it tended to be associated with a shorter hospital stay (P = 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.

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Temporary Abdominal Closure

Hernia Surgery ◽

10.1007/978-3-319-27470-6_40 ◽

2016 ◽

pp. 409-420

Author(s):

William W. Hope ◽

William F. Powers

Keyword(s):

Temporary Abdominal Closure ◽

Abdominal Closure

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Commentary on “Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen”

Southern Medical Journal ◽

10.1097/smj.0b013e318292440f ◽

2013 ◽

Vol 106 (5) ◽

pp. 332-333

Author(s):

Jonathan B. Lundy

Keyword(s):

Trauma Patient ◽

Open Abdomen ◽

Abdominal Closure

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Delayed Primary Closure in Damage Control Laparotomy: The Value of the Wittmann Patch

The American Surgeon ◽

10.1177/000313480707300103 ◽

2007 ◽

Vol 73 (1) ◽

pp. 10-12 ◽

Cited By ~ 9

Author(s):

Josef G. Hadeed ◽

Gregory W. Staman ◽

Hector S. Sariol ◽

Sanjay Kumar ◽

Steven E. Ross

Keyword(s):

Primary Closure ◽

Damage Control ◽

Trauma Surgery ◽

High Rate ◽

Damage Control Laparotomy ◽

Abdominal Closure ◽

Delayed Primary Closure ◽

Accepted Practice ◽

Planned Relaparotomy ◽

Temporary Closure

Damage control laparotomy has become an accepted practice in trauma surgery. A number of methods leading to delayed primary closure of the abdomen have been advocated; complications are recognized with all these methods. The approach to staged repair using the Wittmann patch (Star Surgical Inc., Burlington, WI) combines the advantages of planned relaparotomy and open management, while minimizing the rate of complications. The authors hypothesized that use of the Wittmann patch would lead to a high rate of delayed primary closure of the abdomen. The patch consists of two sheets sutured to the abdominal fascia, providing for temporary closure. Advancement of the patch and abdominal exploration can be done at bedside. When the fascial edges can be reapproximated without tension, abdominal closure is performed. Twenty-six patients underwent staged abdominal closure during the study period. All were initially managed with intravenous bag closure. Eighty-three per cent (20 of 24) went on to delayed primary closure of the abdomen, with a mean time of 13.1 days from patch placement to delayed primary closure. The rate of closure using the Wittmann patch is equivalent to other commonly used methods and should be considered when managing patients with abdominal compartment syndrome or severe abdominal trauma.

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