scholarly journals O14 SHORT STITCH TRIAL 6:1 WITH 4-OH-BUTYRATE (MONOMAX) - FINAL RESULTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Markus Golling ◽  
Zofia Zielska ◽  
Katalyn Maurer ◽  
Petra Baumann
Keyword(s):  
Learning Curve ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Patient Specific ◽  
Emergency Laparotomy ◽  
Specific Data ◽  
Emergency Operations ◽  
Short Stitch ◽  
Wound Length ◽  
Prospective Database

Abstract Aim Surgical technique and material used to close an abdominal wall incision are considered to be important determinants for the risk of developing surgical site occurences (SSOs). Aim of our prospective, non-randomized, monocentric study was a comparative analysis of the perioperative performance (6:1 suture/wound length (SL/WL)-ratio) and SSOs (surgical site infections [SSI] & 2°wound dehiscence/burst abdomen) following midline & transverse incisions. Material and Methods The trial is completed. It included 351 patients between 1/2013-10/2018 in a prospective database. The surgeons aimed at performing a 6:1 SL/WL-ratio in all laparotomies. Patient specific data (risk factors, intra- & postop parameters & SSI/SSO) were entered into the registry database. Satistics involved the Chi2-/ANOVA and Mann-Whitney Test. Results Overall, 82,3% (289/351) were operated electively, 17,7% (62/351) had an emergency laparotomy, 55% (n = 194) had a midline, 29% (n = 103) a transverse and 15% (n = 54) a combined L-shaped laparotomy (liver resection). A learning curve with respect to the bite width was encountered. While SL/WL ratio all laparotomies were similar, bite width varied but improved with experience. SSI was higher in transverse vs. median laparotomies and overall higher in emergency operations. The rate of 2°wound dehiscence (surgical site occurrence [SSO]) stayed at 1/351. Conclusions A learning curve is required to sufficiently perform a short stitch 6:1 suture. Median and transverse laparotomies can be closed safely by a 6:1 SL/WL ratio. SSO could be reduced compared to our historic patient cohort but did not differ within the > and < 6:1 ratio. Emergency laparotomies can also be safely performed with the short stitch technique.

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

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Adomas Gudelis ◽  
Gintaras Simutis ◽  
Julius Pacevicius
Keyword(s):  
Abdominal Wall ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
University Hospital ◽  
Wound Complications ◽  
Tertiary Referral Centre ◽  
Midline Laparotomy ◽  
Group A ◽  
Wound Length

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.

TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eleanor Smith ◽  
Hannah Merriman ◽  
Safia Haidar ◽  
Grace Knudsen ◽  
Victoria Kinkaid ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Intervention Group ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Wound Dressings ◽  
Emergency Laparotomy ◽  
Post Intervention ◽  
Significant Difference ◽  
The Cost

Abstract Aims Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change. Methods In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019. Results We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates. Conclusion While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.

scholarly journals A study to evaluate the effects of various abdominal closure techniques on midline laparotomy wounds in a tertiary care hospital in West Bengal

2021 ◽  
Author(s):  
Subuddha Chatterjee ◽  
Tunisha Bhattacharya
Keyword(s):  
Incisional Hernia ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Health Economy ◽  
P Value ◽  
Care Hospital ◽  
Midline Laparotomy ◽  
Stitch Length ◽  
Short Stitch ◽  
Wound Length

Background: Post-operative complications of wound repair after laparotomy pose a major threat to life as well as to the health economy of a developing nation. Among many other factors, the length of suture used during wound closure has been studied for long. A prospective randomized control study comprising of 104 patients was conducted in the department of surgery of Bankura Sammilani medical college for comparing the incidence of SSI, wound dehiscence and incisional hernia after using short stitch and long stitch for repairing midline laparotomy wounds.Methods: Out of 104 patients enrolled in the study, 51 patients were randomly allocated to short stitch group (suture length: wound length>4:1) and 53 patients were allocated to long stitch group (suture length: wound length=4:1) and both the groups were subsequently followed up for development of the three complications.Results: Data analysis revealed that 11.7 % patients in short stitch group developed SSI whereas 24.5% patients in long stitch group developed SSI. Wound dehiscence occurred in 5.8 % of patients in short stitch group against 15% in long stitch group. 7.8% patients in short stitch group developed incisional hernia against 20.7% patients in long stitch group. In all three situations, p value was significant (<0.05).Conclusions: It is concluded from our study that, the rate of SSI, wound dehiscence and incisional hernia is significantly lower in midline abdominal wounds closed with short stitch length than those closed with long stitch length.

Evaluation of a computerized cardiovascular simulation system using patient-specific data

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
M Kaur ◽  
N Sprunk ◽  
U Schreiber ◽  
R Lange ◽  
J Weipert ◽  
...  
Keyword(s):  
Simulation System ◽  
Patient Specific ◽  
Specific Data ◽  
Cardiovascular Simulation

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

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.

scholarly journals Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Ahmed Siddique Ammar ◽  
Syed Asghar Naqi ◽  
Shehrbano Khattak ◽  
Ahmed Raza Noumani
Keyword(s):  
Sampling Technique ◽  
Wound Dehiscence ◽  
P Value ◽  
Emergency Laparotomy ◽  
Abdominal Wound ◽  
Creative Commons ◽  
Surgical Ward ◽  
Group A ◽  
Abdominal Wound Dehiscence ◽  
Group B

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed. doi: https://doi.org/10.12669/pjms.37.4.3671 How to cite this:Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci. 2021;37(4):1118-1121.  doi: https://doi.org/10.12669/pjms.37.4.3671 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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