scholarly journals Comparative study of wound sequlae in layer closure and retention closure of midline laparotomy

2019 ◽  
Vol 6 (9) ◽  
pp. 3316
Author(s):  
Euvalingam D. ◽  
Sendhil Nathan
Keyword(s):  
Comparative Study ◽  
Outcome Measures ◽  
Wound Closure ◽  
Single Layer ◽  
Complication Rates ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Suture Group ◽  
Group A ◽  
Time Required

Background: Layered closure of the abdomen has been considered to be ideal until recently however single layer mass (retention) closure technique, in which all the layers of the abdominal wall are closed in single layer is being increasingly used by surgeons. We conducted this study to analyze outcome measures in patients in whom wound closure was done by retention closure and layered closure.Methods: This was a prospective comparative study in which 60 patients undergoing elective or emergency laparotomy were included on the basis of a predefined inclusion and exclusion criteria. In 30 cases (50%) layer closure was done whereas in remaining 30 (50%) patients retention closure technique was used. Major outcome measures studied were time required for wound closure and post-operative complications.Results: Out of 60 studied cases there were 42 (70%) males and 18 (30%) females with M: F ratio of 1: 0.42.The time required for closure in layered suture group (group A) was 26.76±3.36 whereas in case of retention closure suturing it was 19.36±4.35. The difference was found to be statistically highly significant (p<0.0001). The complications rates were found to be statistically significantly higher in layer suturing (Group A) as compared to retention suture group (Group B).Conclusions: We conclude that retention suturing is preferable as compared to layered suturing in patients undergoing midline laparotomy in terms of time required for closure of wound and post-operative complication rates.

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.

Continuous suturing as a wound closure technique for circumcisions

2019 ◽  
Vol 12 (6) ◽  
pp. 470-473
Author(s):  
Manoj Ravindraanandan ◽  
Herman Fernando ◽  
Shahjahan Aslam
Keyword(s):  
Male Circumcision ◽  
Wound Closure ◽  
Suture Technique ◽  
Complication Rates ◽  
Continuous Suture ◽  
Single Institution ◽  
Closure Technique ◽  
Level Of Evidence ◽  
Operative Complications ◽  
Low Incidence

Male circumcision is an extremely common urological procedure worldwide, with many variations in technique. Despite the large volume there is a low incidence of complications associated with circumcisions, with the majority being Clavien-Dindo I or II. In this study, we analyse the outcomes and complication rates associated with a continuous wound closure following a male circumcision. Methods: In a urology department from a single institution, 201 male circumcisions with a continuous wound closure were performed in a 4-year period. Outcomes were analysed retrospectively looking at postoperative complications and readmissions to hospital via our clinical portal. Results: No patients had complications that required admission or re-operation at our institution. Conclusion: No major post-operative complications were observed from our cohort. There were also no documented admissions back to our institution with wound healing complications. However, a limitation is that Clavien-Dindo I and II complications and treatment at general practitioner surgeries were not captured and may not accurately represent our complication rates quoted. Nevertheless, we can conclude from these data that closure for a circumcision using a continuous suture technique gives favourable outcomes with acceptable complication rates. Level of evidence: Not applicable for this multicentre audit.

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

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.

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.

BARBED SUTURE FOR LAPAROTOMY CLOUSURE IN URGENCY PROCEDURES. RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
M Bosch-Ramírez ◽  
C Lillo-García ◽  
L Sánchez-Guillén ◽  
A Fernández-Candela ◽  
C Curtis-Martínez ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Barbed Suture ◽  
Continuous Suture ◽  
Midline Laparotomy ◽  
Emergency Procedures ◽  
European Hernia Society ◽  
Suture Group ◽  
Group A ◽  
One Year ◽  
Group B

Abstract INTRODUCTION Urgency surgeries are often performed in a stressful setting, out of hours and with critical patient involved. In this context, laparotomy closure can sometimes be deficient. Suture recommended by European Hernia Society is slowly absorbable monofilament continuous suture with a “small bites” technique. Barbed sutures appear as an alternative to conventional suture, frequently used in laparoscopic procedures due to its’ intrinsic maintenance of traction. The aim of this study is to describe the results in terms of short and mid-term rate of incisional hernia after urgency midline laparotomy, according to the suture utilized. MATERIAL AND METHODS A single-center retrospective cohort study was performed including patients with urgency midline laparotomy during 2018. Group A was represented by patients with slowly absorbable monofilament continuous suture. Group B included patients with barbed suture laparotomy closure. Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging. RESULTS A total of 68 of patients (36 on group A; 32 Group B) were included. On Group A, 13.9% (5) patients presented incisional hernia on the month follow-up, whereas none did on Group B. After a year, Group A only had 1 new case, but 12.5% of patients did herniate on group B; with no significantly relation with obesity neither underlying neoplasm. CONCLUSIONS Midline laparotomy closure must be performed within quality standards, as “small bites” technique with the ratio at least 4/1. Barbed suture appears as a promising closure option, especially in emergency procedures, but needs further study.

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

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

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 Evaluating Effectiveness of Medical Grade Honey-Containing Alginate Dressing in Patients with Chronic Lower Extremity Wounds

2021 ◽  
Vol 17 (3) ◽  
pp. 178-186
Author(s):  
Yeon Ji Lee ◽  
Kyeong Soo Park ◽  
Dong Yeon Kim ◽  
Hyung-Sup Shim
Keyword(s):  
Lower Extremity ◽  
Wound Closure ◽  
Chronic Wounds ◽  
Resistant Bacteria ◽  
Wound Area ◽  
Beneficial Effects ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Time Required

Background: Chronic wounds of the lower extremities are challenging to treat. Recently, honey-based dressings have been shown beneficial effects in diabetic foot ulcers and venous ulcers. Here, we compared Medihoney alginate with a standard alginate dressing in lower extremity chronic wounds.Methods: We performed retrospective chart reviews of 37 patients between January 2019 and January 2021 with chronic lower extremity wounds who were treated with an Algisite M dressing (group A) or a Medihoney alginate dressing (group B). Microorganisms isolated from wound cultures, weekly decrease in wound area over 4 weeks, the number of patients who achieved complete wound closure, and the amount of time required for wound closure were compared between the two groups. Results: Sixteen patients were assigned to group A and 21 to group B. The isolated microorganisms were confirmed as methicillin-susceptible Staphylococcus aureus most commonly, followed by methicillin-resistant S. aureus. Wound area decreased from 12.71 to 2.34 cm<sup>2</sup> in group A and from 14.07 to 1.71 cm<sup>2</sup> in group B (P<0.05). Seven patients achieved complete wound closure in group A (43.75%) and 15 patients in group B (71.43%). Mean duration of wound closure was 36.31 days in group A and 34.62 days in group B.Conclusion: Considering the more rapid decrease in wound area in group B, application of a honey-containing alginate dressing to lower extremity chronic wounds, especially those infected with antibiotic-resistant bacteria, was proved to be a good treatment option.

scholarly journals Comparison of conventional closure versus “re-modified Smead Jones” technique of single layer mass closure with Polypropylene (prolene) loop suture after midline laparotomy in emergency cases

2017 ◽  
Vol 4 (9) ◽  
pp. 3058
Author(s):  
Raxith Sringeri ◽  
Thulasi Vasudeviah
Keyword(s):  
Single Layer ◽  
Wound Infection Rate ◽  
Late Complications ◽  
Midline Laparotomy ◽  
Generalized Peritonitis ◽  
Number Of Patients ◽  
Major Disaster ◽  
Group A ◽  
Low Incidence ◽  
Group B

Background: The occurrence of sudden disruption of the abdominal laparotomy wound is a major disaster in the life of a patient who has undergone an abdominal operation and a major psychological blow to the patient as well as the surgeon.Methods: 100 consecutively enrolled patients who underwent emergency midline laparotomies were enrolled in the study who were admitted in Department of Surgery, JSS University, Mysore and intra-operatively randomized into two groups in 1:1 pattern.Results: The total number of patients who underwent laparotomy for generalized peritonitis in 2 years was 100. The post-operative wound infection rate in Group A was 32.4% and in Group B was 12.3% (p = 0.03) and 95% CI (1.083-7.326).Conclusions: Present study concluded that the modified version of Smead-Jones techniques of laparotomy closure with prolene loop had very low incidence of early and may reduce the late complications. It was superior to other conventional methods of closure.

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