Surgical Site Infection and Analytic Morphometric Assessment of Body Composition in Patients Undergoing Midline Laparotomy

Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

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Role of intraoperative wound irrigation with antibiotics in reducing surgical site infection in patients undergoing contaminated and dirty midline laparotomy surgical wound: a pilot study

International Surgery Journal ◽

10.18203/2349-2902.isj20182780 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2595

Author(s):

Sandhiya P. ◽

Sureshkumar S. ◽

Vijayakumar C. ◽

Palanivel C.

Keyword(s):

Pilot Study ◽

Surgical Site Infection ◽

Rectus Sheath ◽

Control Group ◽

Site Infection ◽

Surgical Wound ◽

Wound Irrigation ◽

Midline Laparotomy ◽

The Difference ◽

Length Of Hospitalization

Background: This study was carried to assess the effect of antibiotic wound irrigation in reducing the surgical site infection (SSI) in the patients undergoing midline laparotomy with contaminated and dirty surgical incision wound.Methods: All patients operated with class-IV- dirty and class III (contaminated) abdominal operative wound according to CDC (Centre for Disease Control and Prevention) were included in this pilot study. Study patients were divided into antibiotic irrigation group and control group. In control group, after rectus sheath closure, the wound was irrigated with 100 mL of normal saline before the skin closure. In antibiotic irrigation group, after rectus sheath closure, the wound was irrigated with Ceftriaxone (10 mL) and Metronidazole (100 mL). Incidence of SSI, degree of SSI and length of hospitalization were compared between two groups.Results: A total of 40 patients were included in the study, 20 in each group. Both the groups were comparable with respect the age, gender, co-morbidities and class of surgical wound. The incidence of SSI was lesser [10% versus 35%; p=0.06] in the antibiotic irrigation group compared to control group. However, the difference was not statistically significant. The length of hospitalization between the groups were comparable [13.5 versus 14.7 days; p=0.74]. The pain score was also not significantly different between the two groups.Conclusions: On comparing to saline irrigation, antibiotic irrigation in patients with contaminated and dirty operative wound results in a lesser SSI with comparable hospital stay and postoperative pain. However, the difference was not statistically significant.

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P107 PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab395.100 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Edgard Efren Lozada Hernandez ◽

Juan Pablo Hernandez Bonilla ◽

Enrique Obregon Moreno ◽

Diego Hinojosa Ugarte ◽

Aldo Jimenez Herevia ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Incisional Hernia ◽

Surgical Site Infection ◽

Meta Analysis ◽

Wound Dehiscence ◽

Site Infection ◽

Closure Technique ◽

Midline Laparotomy ◽

Significant Difference

Abstract Aim “Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia.” Material and Methods “A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included, and the random effects method was used for their analysis. PROSPERO registration number: CRD42021231107” Results “Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection.” Conclusions “The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.”

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Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

Life ◽

10.3390/life11020138 ◽

2021 ◽

Vol 11 (2) ◽

pp. 138

Author(s):

Gearóid Mc Geehan ◽

Itoro M. Edelduok ◽

Magda Bucholc ◽

Angus Watson ◽

Zsolt Bodnar ◽

...

Keyword(s):

Systematic Review ◽

Surgical Site Infection ◽

World Literature ◽

Meta Analysis ◽

Cochrane Library ◽

Emergency Laparotomy ◽

Site Infection ◽

Emergency General Surgery ◽

Midline Laparotomy ◽

Factors Affecting

Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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A High Visceral-To-Subcutaneous Fat Ratio is an Independent Predictor of Surgical Site Infection after Gastrectomy

Journal of Clinical Medicine ◽

10.3390/jcm8040494 ◽

2019 ◽

Vol 8 (4) ◽

pp. 494

Author(s):

Jung Ho Kim ◽

Jinnam Kim ◽

Woon Ji Lee ◽

Hye Seong ◽

Heun Choi ◽

...

Keyword(s):

Body Composition ◽

Surgical Site Infection ◽

Subcutaneous Fat ◽

Area Under The Curve ◽

Predictive Performance ◽

Site Infection ◽

Muscle Area ◽

Visceral Fat Area ◽

Logistic Regression Models ◽

Logistic Analysis

Recent studies have shown that body composition is an important factor that affects surgical site infection (SSI). However, each study has utilized different body composition criteria. Therefore, in this study, we aim to determine the most predictable body composition criteria for the prediction of SSI after gastrectomy. The visceral fat area (VFA), subcutaneous fat area (SFA), and muscle area were assessed by a preoperative-stage computed tomographic (CT) scan. To compare the predictive performance of body composition for SSI, logistic regression models were used, and the models were compared using the receiver operation characteristic (ROC) curve and the area under the curve (AUC) value. Of the 1038 eligible patients, 58 patients (5.6%) developed SSI. The VFA-to-SFA ratio showed the best predictive performance (mean AUC 75.11). The cutoff value for the SSI of the VFA-to-SFA ratio was 0.94, and the sensitivity and specificity were 67.86% and 77.65%, respectively. A multivariate logistic analysis indicated that a total gastrectomy (OR, 2.13; p = 0.017), stage III or IV cancer (OR, 2.66; p = 0.003), and a high VFA-to-SFA ratio (OR, 8.09; p < 0.001) were independent risk factors for SSI after gastrectomy. The VFA-to-SFA ratio is the most predictable body composition model for use in predicting the incidence of SSI after gastrectomy.

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