Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases

Background: A midline incision is simple, quick, bloodless and provides excellent exposure. So it is most commonly used access route for emergency laparotomy. But compare to other incision it increases incidence of postoperative wound dehiscence and an incisional hernia. Prevention of this complication is important in reducing post-operative morbidity and mortality. Present study was undertaken to compare the effectiveness of modified Smead Jones versus conventional continuous closure technique in terms of wound infection and wound dehiscence.Methods: A total of 100 patients from July 2017 to November 2019 were randomized in two groups of 50 each. Group A in which linea alba closure was done by modified Smead Jones technique and group B in which linea alba closure was done by conventional continuous closure technique.Results: 12 patients in group A and 28 patients in group B developed wound infection and 1 patient in group A and 7 patients in group B developed wound dehiscence.Conclusions: Modified Smead Jones technique is better than conventional continuous closure technique in management of closure of emergency midline laparotomy.

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Prevention of Incisional Hernia in Ovarian Cancer Patients Undergoing Midline Laparotomy

10.21203/rs.3.rs-1020551/v1 ◽

2021 ◽

Author(s):

Berta Fabregó Capdevila ◽

Ester Miralpeix ◽

Josep-Maria Solé-Sedeño ◽

José-Antonio Pereira ◽

Gemma Mancebo

Keyword(s):

Ovarian Cancer ◽

Social Impact ◽

Statistical Significance ◽

Fascial Closure ◽

Borderline Ovarian Tumor ◽

Mesh Group ◽

Midline Laparotomy ◽

Mesh Placement ◽

The Social

Abstract BACKGROUND: Incisional hernias (IH) are a frequent complication of midline laparotomies in abdominal surgery. This study was conducted in order to determine the efficacy of mesh placement and assess the optimal fascia closure technique to reduce the IH rate in patients surgically treated after being diagnosed with malignant or borderline ovarian tumors.METHODS: Retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer in Hospital del Mar, Barcelona, from January 2008 to December 2019 were collected. Patient demographic, preoperative and intraoperative characteristics and risk factors for hernia were reported. The incidence of IH between groups (mesh and non-mesh) and the technique used in fascial closure for each patient (small bites technique vs large tissue bites) was reported. RESULTS: In total, 133 patients with available data for follow-up were included. After clinical and radiological examination, 25 (18.79%) of them showed IH. 18 of 61(29.5%) patients in non-mesh group developed IH, compared with 7 of 72 (9.7%) in mesh group (OR 0.25, 95% CI 0.09-0.66, p<0.005). Patients of large tissue bites group showed higher prevalence of IH compared with small bites technique group without statistical significance (OR 0.46, 95% CI 0.17-1.24, p=0.119). The combination of mesh reinforcement and small bites technique for fascial closure significantly reduce IH risk (p=0.021). CONCLUSION: Incidence of IH is high in patients undergoing midline laparotomy for ovarian cancer or borderline ovarian tumor. The addition of a prophylactic mesh and use of small bites technique may reduce the incidence of IH and potentially minimize the social impact and costs of this complication.

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A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20172403 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2014

Author(s):

Rahul D. Kunju ◽

Vinayak Thakkannavar ◽

Shrivathsa Merta K. ◽

Sachin H. G. ◽

Allen Netto ◽

...

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Wound Closure ◽

Tertiary Care ◽

Fascial Closure ◽

Emergency Laparotomy ◽

Closure Technique ◽

Burst Abdomen ◽

Midline Laparotomy ◽

Laparotomy Wound

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

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Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial): study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-019-3921-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Patrick Heger ◽

Manuel Feißt ◽

Johannes Krisam ◽

Christina Klose ◽

Colette Dörr-Harim ◽

...

Keyword(s):

Abdominal Surgery ◽

Abdominal Wall ◽

Fascial Closure ◽

Abdominal Wall Closure ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Randomized Controlled ◽

Onlay Technique ◽

Mesh Augmentation ◽

Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. Trial registration German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.

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Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial

Updates in Surgery ◽

10.1007/s13304-021-01125-0 ◽

2021 ◽

Author(s):

S. Honig ◽

H. Diener ◽

T. Kölbel ◽

W. Reinpold ◽

A. Zapf ◽

...

Keyword(s):

Incisional Hernia ◽

Controlled Trial ◽

Fascial Closure ◽

Absorbable Suture ◽

Double Blind ◽

Midline Laparotomy ◽

Mesh Augmentation ◽

Onlay Mesh ◽

Randomised Controlled

AbstractThe reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.

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Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

10.21203/rs.2.13713/v1 ◽

2019 ◽

Author(s):

Patrick Heger ◽

Manuel Feißt ◽

Johannes Krisam ◽

Christina Klose ◽

Colette Dörr-Harim ◽

...

Keyword(s):

Abdominal Surgery ◽

Abdominal Wall ◽

Fascial Closure ◽

Abdominal Wall Closure ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Randomized Controlled ◽

Onlay Technique ◽

Mesh Augmentation ◽

Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques incisional hernia rates are reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia rates, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination.Methods The HULC trial is a multicentre randomized controlled, observer and patient blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in onlay technique. The primary endpoint will be the occurrence of incisional hernias as defined by the European Hernia Society within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes.Discussion The HULC trial will address the yet unanswered question whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the rate of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

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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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