P100 EARLY POSTOPERATIVE WOUND COMPLICATIONS AFTER MIDLINE LAPAROTOMY CLOSURE WITH SMALL BITES TECHNIQUE: EXPERIENCE FROM A TERTIARY REFERRAL CENTRE

Abstract Aim To analyze the incidence and risk factors of surgical site infections (SSI) and wound dehiscence (WD) after closure of primary midline laparotomies with small-bites (SB) technique. Material and Methods Retrospective analysis using hospital prospective database of all midline abdominal wall closures (AWC) with SB technique performed in a University Hospital between December 2019 and February 2021. To achieve a proper protocol of AWC with SB technique, it is advised to have suture/wound length (SL/WL) – ratio of more than 4:1. Statistical analysis of the incidence of SSI and AWD, comparing the results when the protocol was properly used (A group) or not (B group), was performed. Between groups, no relevant differences were observed for patient characteristics. Results A total of 108 midline laparotomies were included for analysis. 55.5% of patients were male. The mean age was 62.8 years, mean body mass index was 24.3 kg/m2. 78.7% (85/108) were operated electively. SSI and WD have been recorded in 7 (6.5%) and 8 (7,4%) cases respectively. In 65 (60,2%) patients abdominal wall closure after primary laparotomy was achieved with proper protocol (group A). Median SL/WL in A and B group was 4.57 and 3.43 respectively. The rate of WD in A group (n = 1, 1,5%) was significantly (P=.006) lower than in B group (n = 7, 16,3%). Incidence of SSI was 7,7% (n = 5, A group) vs. 4,7% (n = 2; B group) (P=.420). Conclusions Using a proper AWC protocol has been effective to prevent WD in midline laparotomy.

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A comparative study between continuous and x-interrupted sutures in emergency midline laparotomies

International Surgery Journal ◽

10.18203/2349-2902.isj20181437 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1753

Author(s):

Shashikala V. ◽

Abhilash S. B. ◽

Abhishek G. ◽

Prajwal S. Fernandes

Keyword(s):

Suture Material ◽

Rectus Sheath ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Midline Laparotomy ◽

Group A ◽

Common Technique ◽

Laparotomy Wound ◽

Group B ◽

Time Required

Background: Midline laparotomy is the most common technique of abdominal incisions in both emergency and elective settings. Wound dehiscence is related to several factors pertaining to patient besides suture material and method of closure. This study tries to compare continuous sutures with x-interrupted sutures in mass closure of midline laparotomy wound in patients undergoing emergency midline laparotomy for acute peritonitis.Methods: A total of 60 patients undergoing emergency midline laparotomy for secondary peritonitis were considered for the study, 30 of whom underwent closure of abdominal wall with continuous sutures (Group A) and the other 30 with x-interrupted sutures (Group B) using non-absorbable, monofilament, polypropylene suture. Necessary preoperative data, the time required for rectus closure, length of the suture material required, post-operative complications like surgical site infection, wound dehiscence were analyzed.Results: The groups were comparable in means of age and sex distribution. Group A was found to have lesser time for closure of rectus, lesser suture length and lesser suture to wound length ratio when compared with Group B. Surgical site infections were similar in both groups. Patients with rectus sheath sutured in x-interrupted sutures (n=2) had significantly less wound dehiscence as compared with continuous sutures (n=8) (p<0.05).Conclusions: Interrupted -X suture method of suturing reduces post-operative wound dehiscence, although requires more suture and consumes more time than the continuous method of suturing.

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Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20181112 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1368

Author(s):

G. V. Manoharan ◽

T. Sivakumar ◽

M. Ashok Kumar

Keyword(s):

Hospital Stay ◽

Abdominal Wall ◽

Subcutaneous Tissue ◽

Wound Dehiscence ◽

Wound Complications ◽

Skin Closure ◽

Abdominal Wall Closure ◽

Duration Of Hospital Stay ◽

Group A ◽

Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay.

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Abdominal Wall Thickness is a Predictor for Surgical Site Infections in Patients Undergoing Colorectal Operations

The American Surgeon ◽

10.1177/0003134820956932 ◽

2020 ◽

pp. 000313482095693

Author(s):

Yu-Wei W. Chang ◽

Kyle Murphy ◽

Daniel Yackzan ◽

Sarah Thomas ◽

Danielle Kay ◽

...

Keyword(s):

Risk Factor ◽

Abdominal Wall ◽

Wall Thickness ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Abdominal Circumference ◽

Fat Percentage ◽

University Of Kentucky ◽

Improvement Project ◽

Acs Nsqip Database

Background Surgical site infections (SSIs) are an established complication following colorectal operations, with rates up to 30% reported in the literature. Obesity is a known risk factor for SSI; however, body mass index (BMI), body fat percentage, waist-hip ratio, or abdominal circumference are imperfect measures. The purpose of our study was to determine whether abdominal wall thickness (AWT) is predictive of SSI. Methods We queried our American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database for patients (age ≥18 years) undergoing a colectomy at the University of Kentucky (UK) from January 1, 2013 to December 31, 2018. The exclusion criteria included patients with open abdomens or the lack of preoperative computed tomography (CT) within 3 months of their operation. AWT was measured at the level of the anterior superior iliac spine (ASIS) on abdominal CT. SSI was defined by superficial SSI, deep SSI, and wound dehiscence. Results Of 1261 patients enrolled, 52.2% were female, with an average age of 57.4 years. More patients had laparoscopic operations (51%), and the median length of stay was 7 days. Our study demonstrated an SSI rate of 9.4% and a 30-day readmission rate of 11%. The overall mean AWT was 2.6 cm (range .1-13.1), and patients with the highest AWT quintile were more likely to develop an SSI than the lowest quintile (12% vs. 5%). After controlling for risk factors and confounders, the odds of an SSI were 3.6 times higher for patients with the highest AWT than patients with the lowest AWT. Conclusions Among colorectal surgery patients, AWT is an independent risk factor predictive for SSI.

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WOUND DEHISCENCE;

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.08.59 ◽

2018 ◽

Vol 25 (08) ◽

pp. 1143-1146

Author(s):

Ammrah Tahir ◽

Muhammad Sajid Hameed Ansari ◽

Abdul Waheed Khan

Keyword(s):

Controlled Trial ◽

Wound Dehiscence ◽

Midline Laparotomy ◽

Mass Closure ◽

Generalized Peritonitis ◽

Study Results ◽

Group A ◽

Continuous Mass ◽

Group B ◽

Laparotomy Incision

Objectives: To compare the continuous and interrupted closure in term offrequency of wound dehiscence in emergency midline laparotomy incision. Study Design:Randomized controlled trial. Setting: Surgical Unit-I, Allied Hospital Faisalabad. Period: From15th March 2014 to 15th November 2014. Material and Methods: Two hundred patients werediagnosed clinically by taking thorough history and examinations were included. Fascial layerof wound of the patients sampled for group A was closed with interrupted mass closure withprolene no.1 whereas in group B was closed by continuous mass closure with prolene no1. All included patients were kept nothing by mouth. Resuscitation was done with, ringerslactate and blood transfusion if needed until adequate urine output (0.5 ml/kg/hr). Base lineinvestigations were done. After resuscitation and giving preoperative antibiotics, patients wereexplored through mid-line incision. Obvious source of contamination was dealt with accordingly.Variables wound were examined daily for any sign of dehiscence. Temperature pulse wasmeasured daily along with surgical site examination for any kind of discharge, stitches cutthrough and gut visibility through wound. In case of no complication patient was discharged ontenth postoperative day, which was the end point of study. Results: There were 61 (61%) malesand 39 (39%) females in group A, while in group B, 63 (63%) males and 37 (37%) females withmean ages of patients were 39.77+10.16 and 38.61+9.75 respectively. The wound dehiscencewere found 7 (7%) in Group-A and 18(18%) in Group-B while remaining 93 (93%) in Group-Aand 82 (82%) in Group-B had no morbidity statistically (p<0.01). Conclusion: It is concludedthat wound dehiscence is significantly higher in continuous closure as compare to interruptedclosure for emergency midline laparotomy incision for generalized peritonitis.

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Closure Methods for Midline Laparotomy Incisions Following Abdominal Surgery - A Comparative Study from Central India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/391 ◽

2021 ◽

Vol 8 (24) ◽

pp. 2089-2093

Author(s):

Hari Om Singh Sengar ◽

Kailash Charokar ◽

Prashant Nema

Keyword(s):

Comparative Study ◽

Wound Complications ◽

Absorbable Suture ◽

Midline Laparotomy ◽

Mass Closure ◽

Group A ◽

Group B ◽

Closure Method ◽

Closure Group ◽

Laparotomy Incision

BACKGROUND The method adopted for incision closure has an influence on the outcomes of wound healing. The study was conducted to compare the ‘mass closure’ method with the conventional layer closure, and to find out the suitable surgical closure method for midline laparotomy incision. METHODS A prospective comparative study was conducted at a tertiary care teaching institute over a period of 2 years. Patients > 14 years of age, who were operated on by midline laparotomy incision, were included in the study group (N = 60). Either a ‘mass closure’ or the conventional layer closure method was adopted as per the operating surgeon’s choice. Based on the method used the cases were allocated into two groups, each with 30 patients. In the ‘mass closure’ group (Group A), continuous suturing was used in 22 patients and interrupted closure in 8 patients. In the ‘layered closure’ group (Group B), the abdomen was closed in layers using absorbable suture for the peritoneum (together with transversalis fascia) and non-absorbable for the linea alba. The patients were followed up postoperatively, and for 6 months after discharge from the hospital in follow-up for the detection of the wound complications. RESULTS The mean age of patients in Group A was 40.9 ± 15.48 years, and 41.03 ± 14.73 in Group B. There were 25 males and 5 females in Group A and 23 males and 7 females in Group B. Closure time of incision was significantly lower in the mass closure group (P < 0.05). The postoperative complications in Group A was 20 % (Seroma-1 patient, infection-3, partial wound dehiscence-1, and hernia-1). In Group B, the overall complication rate was 36 % (Seroma-3 patients, infection-5, burst abdomen- 1, hernia- 2). CONCLUSIONS Mass closure method is better than the conventional layer closure for the midline laparotomy incision. KEYWORDS Laparotomy, Layered Closure, Midline Incision, Mass Closure, Suture Technique

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Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

International Surgery Journal ◽

10.18203/2349-2902.isj20200297 ◽

2020 ◽

Vol 7 (2) ◽

pp. 455

Author(s):

Tappa Mahammad Mustaqrasool ◽

Bharat Dikshit ◽

Deepak Phalgune

Keyword(s):

Incisional Hernia ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Suture Technique ◽

Fascial Closure ◽

Abdominal Wound ◽

Closure Time ◽

Small Tissue ◽

Group A ◽

Group B

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

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Evaluation of a new technique for abdominal wall closure in midline laparotomies

International Surgery Journal ◽

10.18203/2349-2902.isj20183188 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2701

Author(s):

Moharam Abdelsamie Mohamed Abd El Shahid ◽

Fawzy Abo Bakre Mahmoud ◽

Said Ebrahim Elmallah

Keyword(s):

Abdominal Wall ◽

Wound Dehiscence ◽

New Technique ◽

Abdominal Wall Closure ◽

University Hospitals ◽

Midline Laparotomy ◽

Randomized Clinical Study ◽

A New Technique ◽

One Year ◽

Critical Aspects

Background: An efficient technique for abdominal wall closure should provide strength and be a barrier against infection. Method of closure and type of suture material are critical aspects of an effective abdominal wall closure after midline laparotomy. Dehiscence of abdominal wounds after closure is a serious complication especially in emergency laparotomies. Our study was done to know whether our method of abdominal closure was helpful in reducing incidence of wound dehiscence.Methods: Present study was carried out as a retrospective randomized clinical study in the department of general surgery, Menoufia University Hospitals for one year starting from March 2017 to March 2018. 168 patients had midline laparotomies (either elective or emergent) for inflammatory, traumatic or neoplastic indications.Results: In present study for this new technique of abdominal wall closure after midline laparotomies, wound infection was noticed in 12/168 (7.2%) cases and 2/168 (1.2%) patients developed wound dehiscence.Conclusions: Present study demonstrates that our new technique (Moharam Repair) of abdominal wall closure after midline laparotomies) is efficient in reducing post-operative wound dehiscence (burst abdomen). So, this technique is applicable, safe, and can minimize morbidities and mortalities related to wound dehiscence (as a short-term complication) after midline exploratory laparotomies (MEL).

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Comparative study between using of quilting sutures vs. using of fibrin sealant in prevention of seroma after abdominoplasty

QJM ◽

10.1093/qjmed/hcab097.058 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Therese Wagih Mickael Isaac ◽

Emad EL Deen Farid ◽

Hesham Mohammed Omran ◽

Ahmed Sobhi Hweidi

Keyword(s):

Abdominal Wall ◽

Fibrin Glue ◽

Surgical Repair ◽

Body Contouring ◽

Aesthetic Surgery ◽

University Hospital ◽

University Hospitals ◽

Drain Removal ◽

Group A ◽

Group B

Abstract Background Abdominoplasty is one of the most common body-contouring procedures. It is among the top five procedures in aesthetic surgery. The aim of abdominoplasty is to remove excess fat and skin and restore weakened muscles to create smoother firmer abdominal figure Aim of study The aim of the present study is to compare between the rate of seroma in patients undergone abdominoplasty using quilting sutures technique and patients undergone abdominoplasty using fibrin glue. Patients and Methods This study was conducted on 20 patients complaining of variable degrees of abdominal wall laxity seeking for surgical repair of abdominal wall, conducted from april 2019 till october 2019.on patients admitted at ain shams university hospitals and cairo university hospitals Results This study includes twenty patients with abdominal wall redundancy presented to Ain-Shams university hospital and kasr AL Ainy university hospital in the period (April 2019 - October 2019). The patients were divided into two groups: group A ten patients undergone abdominoplasty with quilting sutures technique, group B ten patients undergone abdominoplasty with fibrin glue. All 20 patients were females aging between 25 and 50 and with BMI between 25 and 30. Conclusion Within the limitations of our study we have concluded that this study adds to the mounting evidence that placement of quilting sutures or the application of fibrin glue is safe and effective and will contribute to a decrease in the seroma rate, the total amount of drain output, the time of drain removal and complications. It produces a safe and less eventful postoperative period.

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Anal Sphincteroplasty in the Minimally Invasive Era: Assessment of National Trends and Complications

The American Surgeon ◽

10.1177/000313481908500123 ◽

2019 ◽

Vol 85 (1) ◽

pp. 46-51 ◽

Cited By ~ 1

Author(s):

Evgeniy I. Kreydin ◽

Zaid Q. Chaudhry ◽

Kevork K. Kazanjian ◽

Anne Y. Lin

Keyword(s):

Fecal Incontinence ◽

Wound Dehiscence ◽

Patient Characteristics ◽

The United States ◽

Perioperative Outcomes ◽

National Study ◽

Wound Complications ◽

Patient Counseling ◽

Novel Therapy ◽

Anal Sphincteroplasty

Fecal incontinence is a debilitating and underreported condition. Despite introduction of novel therapies in recent years, anal sphincteroplasty (AS) remains the surgical choice for certain patients. Previous reports have primarily focused on single-surgeon or single-center experience with AS. The purpose of this study was to assess patient characteristics and perioperative outcomes of AS using a national cohort. Patients (n = 586) who underwent AS as a primary procedure between 2009 and 2015 were identified by the CPT code as recorded in the study and were evaluated and examined for association with 30-day complications. The number of sphincteroplasties performed decreased seven-fold between 2009 and 2015. Wound infection, wound dehiscence, and urinary tract infection were the most common complications, occurring in 30 (5.1%), 12 (2.1%), and 6 (1%) patients, respectively. Preoperative steroid use and surgeon specialty were associated with wound complications on multivariate analysis. We present the first national study of patients undergoing AS and identify factors that predispose to wound complications. In addition, we demonstrate that the number of anal sphincteroplasties performed in the United States is decreasing dramatically, likely because of novel therapy for fecal incontinence. We hope that this study will assist in patient counseling and call attention to preserving surgical training as utilization of AS rapidly declines.

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Coagulation Laboratory Testing Is Predictive of Wound Complications Following Microdiscectomy

Global Spine Journal ◽

10.1177/2192568218764677 ◽

2018 ◽

Vol 9 (2) ◽

pp. 138-142

Author(s):

Vadim Goz ◽

Nikita Lakomkin ◽

Ali Jalali ◽

Darrel S. Brodke ◽

William R. Spiker

Keyword(s):

Postoperative Complications ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Cost Effective ◽

International Normalized Ratio ◽

Wound Complications ◽

Improvement Program ◽

Logistic Regression Models ◽

American Society ◽

Tract Infections

Study Design: Retrospective review. Objective: To determine whether abnormal preoperative testing is associated with postoperative complications in patients undergoing a microdiscectomy. Methods: Patients undergoing a microdiscectomy between 2006 and 2013 were identified in the National Surgical Quality Improvement Program database based on appropriate current procedural terminology coding. Thirty-day postoperative complications were analyzed in addition to patient demographics, comorbidities, and abnormal preoperative laboratory values. A series of over 650 univariate analyses to determine which independent variables to include for each complication were completed. Based on those analyses, 12 logistic regression models were built, one for each specific complication. Each model adjusted for age, gender, comorbidities, American Society of Anesthesiologists classification, as well as operative time. Results: A total of 5947 patients undergoing a microdiscectomy were included in the study. Abnormal preoperative international normalized ratio (odds ratio [OR] = 5.85, P < .05) was associated with any wound infection, superficial or deep, and abnormal partial thromboplastin time was significantly associated with wound dehiscence (OR = 6.80, P < .05). Postoperative urinary tract infections were associated with abnormal preoperative hematocrit (OR = 8.00, P < .05). None of the identified preoperative labs were independently associated with pulmonary embolism, organ space surgical site infections, or intubation. Conclusions: Abnormal preoperative coagulation labs were significantly associated with postoperative wound complications. However, the majority of tests were not associated with adverse events following microdiscectomy. Further study is necessary to conclude whether these tests provide information that can modify perioperative management and whether widespread testing is cost-effective.

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