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

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.

scholarly journals Prospective comparative study of modified Smead Jones versus conventional continuous method of fascial closure in emergency midline laparotomy

2020 ◽  
Vol 7 (11) ◽  
pp. 3713
Author(s):  
Chirag B. Aghara ◽  
Ajay M. Rajyaguru ◽  
Jatin G. Bhatt
Keyword(s):  
Wound Infection ◽  
Fascial Closure ◽  
Emergency Laparotomy ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Linea Alba ◽  
Hernia Prevention ◽  
Group A ◽  
Group B ◽  
Continuous Closure

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. 

scholarly journals Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

2018 ◽  
Vol 5 (2) ◽  
pp. 584 ◽  
Author(s):  
Santoshkumar N. Deshmukh ◽  
Audumbar N. Maske
Keyword(s):  
Comparative Study ◽  
Wound Closure ◽  
Tertiary Care ◽  
Cost Effective ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Prospective Comparative Study ◽  
Laparotomy Wound ◽  
Closure Group

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon. The best abdominal closure technique should be fast, easy, and cost effective while preventing both early and late complications. Present study is undertaken to compare the two methods (Mass closure and Layered closure) of laparotomy wound closure in relation to post-operative complications, time for wound closure and cost effectiveness in both groups and also to decide the most effective method among the two.Methods: This prospective comparative study was conducted in department of surgery at a tertiary care teaching hospital at Solapur (Maharashtra) from January 2006 to January 2009. On admission, patients suspected of having intraabdominal pathology, a thorough clinical e and general assessment was done. Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy. The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection late complications.Results: Total 60 patients of were studied. Majority of patients were in 61 to 65 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure. Mean wound closure time is more in layered closure group. Mass closure technique is more cost effective than layered closure group.Conclusions: Mass closure technique is less time consuming, more cost effective and safe for closure of midline laparotomy incisions.

scholarly journals A STUDY ON LAYERED CLOSURE VERSUS MASS CLOSURE OF LAPAROTOMY INCISIONS

2021 ◽  
pp. 48-49
Author(s):  
Therani Dorababu ◽  
Kumaran R
Keyword(s):  
Wound Closure ◽  
Tertiary Care ◽  
Late Complications ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Laparotomy Wound ◽  
Ideal Method ◽  
Closure Group ◽  
The Ideal

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon.The best abdominal closure technique should be fast, easy while preventing both early and late complications. Present study is undertaken to compare the two methods (LAYERED closure and MASS closure) of laparotomy wound closure in relation to postoperative complications,time for wound closure in both groups and also to decide the most effective method among the two. Methods: This study was conducted in department of surgery at a tertiary care teaching hospital at KANCHIPURAM (TAMILNADU) from DECEMBER 2019 to DECEMBER 2020. On admission,patients suspected of having intraabdominal pathology,a thorough clinical examination and general assessment was done.Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy.The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection of late complications. Results:Total 60 patients of were studied.Majority of patients were in 66 -75 age group.Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure.Mean wound closure time is more in layered closure group. Conclusions: Mass closure technique is less time consuming,safe for closure of midline laparotomy incisions.

scholarly journals A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

2020 ◽  
Vol 18 (1) ◽  
pp. 63-66
Author(s):  
Shiv Vansh Bharti ◽  
Anup Sharma
Keyword(s):  
Wound Infection ◽  
Wound Closure ◽  
College Teaching ◽  
Wound Complications ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Abdominal Closure ◽  
Group A ◽  
Laparotomy Wound ◽  
Group B

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

scholarly journals Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

2020 ◽  
Vol 7 (5) ◽  
pp. 1391
Author(s):  
Rajat Sharma ◽  
Amitpal Kaur ◽  
Mohit Sharma ◽  
Karaninder Singh ◽  
Neeti Rajan Singh
Keyword(s):  
Incisional Hernia ◽  
Wound Infection ◽  
Wound Closure ◽  
Elective Surgery ◽  
Comparative Trial ◽  
Suture Technique ◽  
Abdominal Wound ◽  
Midline Laparotomy ◽  
Significant Difference ◽  
Group A

Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.

scholarly journals P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Thomas Korgaard Jensen ◽  
Ismail Gögenur ◽  
Mai-Britt Tolstrup
Keyword(s):  
Incisional Hernia ◽  
High Rate ◽  
Fascial Closure ◽  
Closure Technique ◽  
Burst Abdomen ◽  
Incisional Hernias ◽  
Mass Closure ◽  
Long Term Effect

Abstract Aim This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients. Material and Methods A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias. Results 94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%. Conclusions Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.

Effect of Wound Closure Technique on Wound Infection in the Morbidly Obese: results of a randomized trial

1991 ◽  
Vol 1 (1) ◽  
pp. 33-35 ◽  
Author(s):  
Raphael Chung ◽  
Marion Schertzer ◽  
David Fromm ◽  
Robert Kozol
Keyword(s):  
Wound Infection ◽  
Randomized Trial ◽  
Wound Closure ◽  
Morbidly Obese ◽  
Closure Technique

Layered versus Mass Closure of Vertical Midline Laparotomy Wounds in Negro Africans

1988 ◽  
Vol 18 (2) ◽  
pp. 67-69 ◽  
Author(s):  
Spencer E E Efem ◽  
Akuma Aja
Keyword(s):  
Incisional Hernia ◽  
Infection Rates ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Ancestry Group ◽  
Keloid Formation ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

A prospective comparative study of layered closure versus mass closure of vertical midline laparotomy incisions was undertaken in 314 consecutive patients of indigenous Negroid ancestry. Group A (109 patients) had mass closure and group B (205 patients) had layered closure. The patients were similar in both groups. Group A consisted of 49 (45%) emergencies and 60 (55%) elective cases, and group B of 93 (45%) emergencies and 112 (55%) elective cases. There were 6 cases of burst abdomen and 4 cases of incisional hernia in group B; group A suffered no wound failure. The wound infection rates were 3.7% for group A and 10% for group B. Mass closure carries lower wound failure rates than layered closure of laparotomy wounds, and polyamide sutures do not increase keloid formation in Negro patients.

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

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.

scholarly journals Rate of Wound Infection of Non-traumatic Emergency Laparotomy at a Teaching Hospital in Bangladesh: Experience of 100 cases

2017 ◽  
Vol 2 (1) ◽  
pp. 9-12
Author(s):  
Din Mohammad ◽  
Mahbuba Begum ◽  
Abdur Rabban Talukder ◽  
Md. Abdus Salam
Keyword(s):  
Wound Infection ◽  
Infection Rate ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Positive Culture ◽  
Wound Infection Rate ◽  
Emergency Laparotomy ◽  
Bacteriological Examination ◽  
Postoperative Wound ◽  
Ulcer Perforation

Background: Wound infection is an important issue for surgical operations. Objective: The purpose of the present study was to measure the rate of wound infection of non-traumatic emergency laparotomy cases.Methodology: This descriptive cohort study was carried out in the Department of Surgery at Dhaka Medical College, Dhaka from July 1997 to June 1998 for a period of 1(one) year. Pre-operative patients were carefully assessed for any host factors related to wound infection. Different per-operative factors that influence the rate of postoperative wound infection were also analyzed. Swabs were taken from the suspected postoperative wound and sent for bacteriological examination. Result: In this series, 100 cases of emergency laparotomies (non-traumatic) were analyzed. Bacteriological examination showed positive culture in most of the cases but three were found to be negative result. Wound infection rate of specific type of operation were 12.5%, 20.0%, 6.6%, 40.0%, 40.0%, 33.3%, 50.0%, 50.0%, and 100.0% in duodenal ulcer perforation, pre-pyloric and gastric ulcer perforation, acute appendicitis, burst appendix, ileal perforation, small intestinal obstruction due to bands and adhesions, volvulus of sigmoid colon, obstructed inguinal hernia, generalized peritonitis due to puerperal sepsis respectively. The overall surgical wound infection rate was 19.0%. Conclusion: The rate of wound infection of non-traumatic emergency laparotomy cases are frequently found in a well-established tertiary care teaching hospital. Bangladesh J Infect Dis 2015;2(1):9-12

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