Treatment for Horseshoe Fistulas-In-Ano with Primary Closure of the Internal Fistula Opening: A Clinical and Manometric Study

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Primary closure versus delayed primary closure in reducing surgical site infection in dirty midline abdominal operative wounds- A randomized controlled trial

Medpusle International Journal of Surgery ◽

10.26611/1069210 ◽

2019 ◽

Vol 9 (2) ◽

pp. 86-90

Author(s):

Rakesh Pandey ◽

◽

G K Venkatachalam ◽

B Kanchana ◽

◽

...

Keyword(s):

Randomized Controlled Trial ◽

Surgical Site Infection ◽

Primary Closure ◽

Controlled Trial ◽

Site Infection ◽

Randomized Controlled ◽

Delayed Primary Closure

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Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.1.peds18232 ◽

2019 ◽

Vol 24 (1) ◽

pp. 75-84

Author(s):

Mohammad Sadegh Masoudi ◽

Mohammad Ali Hoghoughi ◽

Fariborz Ghaffarpasand ◽

Shekoofeh Yaghmaei ◽

Maryam Azadegan ◽

...

Keyword(s):

Mortality Rate ◽

Comparative Study ◽

Surgical Site Infection ◽

Latissimus Dorsi ◽

Primary Closure ◽

Wound Dehiscence ◽

Site Infection ◽

Gluteal Muscle ◽

Operative Duration ◽

Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

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Laparoscopic repair of internal hernia with late presentation and primary closure of the mesocolic defect – video correspondence

Colorectal Disease ◽

10.1111/codi.15736 ◽

2021 ◽

Author(s):

Roberto Peltrini ◽

Nello Pirozzi ◽

Mariangela Ilardi ◽

Umberto Bracale ◽

Francesco Corcione

Keyword(s):

Laparoscopic Repair ◽

Internal Hernia ◽

Primary Closure ◽

Late Presentation

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Delayed primary closure (DPC) of the skin and subcutaneous tissues following complex, contaminated abdominal wall reconstruction (AWR): a propensity-matched study

Surgical Endoscopy ◽

10.1007/s00464-021-08485-z ◽

2021 ◽

Author(s):

Sullivan A. Ayuso ◽

Sharbel A. Elhage ◽

Bola G. Aladegbami ◽

Angela M. Kao ◽

Kent W. Kercher ◽

...

Keyword(s):

Abdominal Wall ◽

Primary Closure ◽

Abdominal Wall Reconstruction ◽

Delayed Primary Closure ◽

Subcutaneous Tissues ◽

Matched Study

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Surgical Site Infection Trend Analysis Following Abdominal Hysterectomy, National Healthcare Safety Network, 2009–2018

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1039 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s396-s397

Author(s):

Qunna Li ◽

Minn Soe ◽

Allan Nkwata ◽

Victoria Russo ◽

Margaret Dudeck ◽

...

Keyword(s):

Logistic Regression ◽

Trend Analysis ◽

Primary Closure ◽

Abdominal Hysterectomy ◽

Incidence Rates ◽

Mixed Effects ◽

Mandatory Reporting ◽

Hospital Inpatient ◽

Quality Reporting ◽

Reporting Requirement

Background: Surveillance data for surgical site infections (SSIs) following abdominal hysterectomy (HYST) have been reported to the CDC NHSN since 2005. Beginning in 2012, HYST SSI surveillance coverage expanded substantially as a result of a CMS mandatory reporting requirement as part of the Hospital Inpatient Quality Reporting Program. A trend analysis of HYST SSI using data submitted to the NHSN has not been previously reported. To estimate the overall trend of HYST SSI incidence rates, we analyzed data reported from acute-care hospitals with surgery performed between January 1, 2009, and December 31, 2018. Methods: We analyzed inpatient adult HYST procedures with primary closure resulting deep incisional primary and organ-space SSIs detected during the same hospitalization or rehospitalization to the same hospital. SSIs reported as infection present at time of surgery (PATOS) were included in the analysis. Due to the surveillance definition changes for primary closure in 2013 and 2015, these were tested separately as interruptions to HYST SSI outcome using an interrupted time-series model with a mixed-effects logistic regression. Because the previously described changes were not significantly associated with changes in HYST SSI risk, mixed-effects logistic regression was used to estimate the annual change in the log odds of HYST SSI. The estimates were adjusted for the following covariates: hospital bed size, general anesthesia, scope, ASA score, wound classification, medical school affiliation type, procedure duration and age. Results: The number of hospitals and procedures reported to NHSN for HYST increased and then stabilized after 2012 (Table 1). The unadjusted annual SSI incidence rates ranged from 0.60% to 0.81%. Based on the model, we estimate a 2.58% decrease in the odds of having a HYST SSI annually after controlling for variables mentioned above (Table 2). Conclusions: The volume of hospitals and procedures for HYST reported to NHSN increased substantially because of the CMS reporting requirement implemented in 2012. The overall adjusted HYST SSI odds ratio decreased annually over 2009–2018, which indicates progress in preventing HYST SSIs.Funding: NoneDisclosures: None

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