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

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

British Journal of Surgery ◽

10.1093/bjs/znab395.093 ◽

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.

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A historically controlled, single-arm, multi-centre, prospective trial to evaluate the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy. ISSAAC-Trial [NCT005725079]

BMC Surgery ◽

10.1186/1471-2482-8-12 ◽

2008 ◽

Vol 8 (1) ◽

Cited By ~ 2

Author(s):

Lars Fischer ◽

Petra Baumann ◽

Johannes Hüsing ◽

Christoph Seidlmayer ◽

Markus Albertsmeier ◽

...

Keyword(s):

Abdominal Wall ◽

Suture Material ◽

Prospective Trial ◽

Abdominal Wall Closure ◽

Midline Laparotomy ◽

Safety And Efficacy

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Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele

Pediatric Surgery International ◽

10.1007/s00383-021-04977-0 ◽

2021 ◽

Author(s):

M. Haghshenas ◽

U. Rolle ◽

M. Hutter ◽

T. M. Theilen

Keyword(s):

Abdominal Wall ◽

Surgical Procedures ◽

Retrospective Chart Review ◽

First Year ◽

Special Focus ◽

Abdominal Wall Closure ◽

Gastrointestinal Complications ◽

Secondary Operations ◽

One Year ◽

The One

Abstract Purpose This study aims to define the extent of additional surgical procedures after abdominal wall closure (AWC) in patients with gastroschisis (GS) and omphalocele (OC) with special focus on gastrointestinal related operations. Methods A retrospective chart review was performed including all operations in GS and OC patients in the first year after AWC (2010–2019). The risk for surgery was calculated using the one-year cumulative incidence (CI). Results 33 GS patients (18 simple GS, 15 complex) and 24 OC patients (12 without (= OCL), 12 OC patients with liver protrusion (= OCL +)) were eligible for analysis. 43 secondary operations (23 in GS, 20 in OC patients) occurred after a median time of 84 days (16–824) in GS and 114.5 days (12–4368) in OC. Patients with complex versus simple GS had a significantly higher risk of undergoing a secondary operation (one-year CI 64.3% vs. 24.4%; p = 0.05). 86.5% of surgical procedures in complex GS and 36.3% in OCL + were related to gastrointestinal complications. Complex GS had a significantly higher risk for GI-related surgery than simple GS. Bowel obstruction was a risk factor for surgery in complex GS (one-year CI 35.7%). Conclusion Complex GS and OCL + patients had the highest risk of undergoing secondary operations, especially those with gastrointestinal complications.

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Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583]

Trials ◽

10.1186/1745-6215-13-72 ◽

2012 ◽

Vol 13 (1) ◽

Cited By ~ 4

Author(s):

Nuh N Rahbari ◽

Phillip Knebel ◽

Meinhard Kieser ◽

Thomas Bruckner ◽

Detlef K Bartsch ◽

...

Keyword(s):

Abdominal Wall ◽

Multicenter Trial ◽

Current Status ◽

Abdominal Wall Closure ◽

Midline Laparotomy ◽

Randomized Controlled

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Abdominal wall reconstruction using De-epithelialized dermal flap: A new technique

Journal of Surgical Technique and Case Report ◽

10.4103/2006-8808.63707 ◽

2010 ◽

Vol 2 (1) ◽

pp. 3 ◽

Cited By ~ 5

Author(s):

JN Legbo ◽

JF Legbo

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

New Technique ◽

Dermal Flap ◽

A New Technique

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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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