scholarly journals Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

2020 ◽  
Vol 7 (2) ◽  
pp. 455
Author(s):  
Tappa Mahammad Mustaqrasool ◽  
Bharat Dikshit ◽  
Deepak Phalgune
Keyword(s):  
Incisional Hernia ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Suture Technique ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Closure Time ◽  
Small Tissue ◽  
Group A ◽  
Group B

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

scholarly journals Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy

2019 ◽  
Vol 6 (3) ◽  
pp. 886
Author(s):  
Rajesh Kumar Bansiwal ◽  
Tarun Mittal ◽  
Rajeev Sharma ◽  
Sanjay Gupta ◽  
Simrandeep Singh ◽  
...  
Keyword(s):  
Rectus Sheath ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
Emergency Laparotomy ◽  
Abdominal Wound ◽  
Midline Laparotomy ◽  
Medical College ◽  
Group A ◽  
Abdominal Wound Dehiscence ◽  
Group B

Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.

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.

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 Reducing potential for needle-stick injuries in the operating room

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0041
Author(s):  
Eliana Saltzman ◽  
Daniel Scott
Keyword(s):  
Operating Room ◽  
Posterior Approach ◽  
Wound Closure ◽  
Standard Technique ◽  
Suture Technique ◽  
Needle Stick ◽  
Closure Time ◽  
Group A ◽  
Needle Stick Injuries ◽  
Group B

Category: Other Introduction/Purpose: The CDC estimates that at least 385,000 sharps injuries occur annually among US healthcare workers, which may even be as high as 800,000. Traditionally, wound closure demands the OR scrub tech to pre-load suture needles onto needle drivers that are presented to the surgeon and then passed back once the needle has been used. With frequent passing of contaminated needles, needle-stick injuries occur commonly in the OR. Operative Armour (Sharp Fluidics®, LLC) incorporates a novel needle trap that enables surgeons to independently self-secure and self-dispense suture needles during closure (Fig. 1). We hypothesized that the use of Operative Armour as compared to the standard technique of sequentially passed needles would reduce the number of sutures passes. Methods: Three cadaveric specimens were dissected in this study. A 12 cm long incision was made through an anterior and posterior approach to the ankle joint in each specimen. The incisions were cross-hatched at 1 cm intervals with a surgical marking pen to indicate closure points. Two layers, subcuticular and skin, were closed. All three participants were orthopedic foot and ankle fellows at our institution. All wound closures were done with interrupted suture technique using 2-0 vicryl pop-off suture (Covidien), containing 5 needles per pack. Group A used traditional suture passing from the scrub tech vs the Operative Armour in Group B. The participants completed three trials for each group first through the anterior and then through the posterior approach. Outcome measures included number of needle passes, dropped needles, and closure time. Results: Suture passes averaged 52±8.9 for Group A compared to 5.3±0.7 in Group B (p<0.05). There were 24 needle handoffs in Group A, in Group B only three suture packs were passed. Overall closure time was 16:35±0.2 minutes in Group A and 16:33±0.1 minutes for Group B (p= 0.8). No needles were dropped in either group. For the anterior incision, suture passes averaged 56±11.3 in Group A compared to 5.6±0.9 in Group B (p<0.05). The closure time for Group A was 16:51±0.2 minutes and 16:13±0.1 minutes for Group B (p<0.05). For the posterior incision, suture passes averaged 48±0.0 in Group A compared to 5±0.0 in Group B (p<0.05). The closure time for Group A was 16:18±0.2 minutes and 16:53±0.1 minutes in Group B (p=0.05). Conclusion: Use of the Operative Armour compared to standard technique demonstrated a statistically significant decreased number of suture passes, but no change in total closure time. Given the large reduction in sutures passes, the use of the Operative Armour could lead to a significant reduction in the number of needle sticks in the OR during wound closure. Also, while not measured in this study, the use of Operative Armour could reduce the demand on the scrub tech for assistance with wound closure and could thus decrease OR turnaround time and enhance operating room efficiency.

scholarly journals Evaluation of abdominal wound closure using continuous versus interrupted sutures in patients of perforation peritonitis

2021 ◽  
Vol 8 (3) ◽  
pp. 844
Author(s):  
Arnab Mohanty ◽  
Yoel Dewa Paljor ◽  
Rajeev Sharma
Keyword(s):  
Wound Closure ◽  
Critical Role ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
New Delhi ◽  
Abdominal Wound ◽  
Hollow Viscus ◽  
Single Centre Study ◽  
Perforation Peritonitis ◽  
Group B

Background: The type of wound closure plays a critical role in patients of perforation peritonitis, since many of these patients also have poorly controlled co-morbidities and risk factors for wound dehiscence. Though many studies have evaluated abdominal wound closures in the elective scenario, similar studies in the emergent scenario are rather scarce. Hence, we have dealt with this issue in patients presenting with hollow viscus perforation peritonitis.Methods: This was a prospective randomized case control single-centre study with 120 patients performed at St. Stephen’s Hospital, New Delhi, India between February 2016 and January 2019. These patients were randomized divided into two groups; group A comprising those patients in whom, the abdominal wound was closed with continuous sutures, and group B comprising those in whom it was closed with interrupted sutures. Informed consent was taken from all the patients. A detailed proforma included all parameters. Follow up was conducted at 2, 4, 6 and 12 weeks from the date of surgery. Data analysis was done using S.P.S.S. version 17.Results: The time taken for continuous suture fascial closure was significantly less than the interrupted technique. There were no significant differences in other parameters, immediately or on follow-up.Conclusions: The continuous method of abdominal closure was faster than interrupted suturing on account of the use of only two terminal knots, this difference being statistically significant. The outcomes were comparable to other studies that have dealt with this issue in elective surgeries.

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 Comparison of suture technique (interrupted vs. continuous) with respect to wound dehiscence

2020 ◽  
Vol 72 ◽  
pp. 191-194
Author(s):  
Gopal Sharma ◽  
Nivedita Prashar ◽  
Nikita Gandotra
Keyword(s):  
Wound Infection ◽  
Wound Dehiscence ◽  
Suture Technique ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Continuous Suture ◽  
Midline Laparotomy ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: Post-operative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today. The quest for the best closure technique for abdominal incisions continues. To achieve this goal, several modifications in opening the abdomen and closing the wound have been tried. There are many studies in the literature comparing various methods of wound closure, with conflicting results. The aim of the present study was to assess the proportion of wound infection and wound dehiscence in the post-midline laparotomy patients, using interrupted X suture versus continuous suture technique in sheath closure. Material and Methods: A total of 80 patients undergoing vertical midline emergency laparotomy at one of the gynecology units were recruited randomly after taking written informed consent and were equally divided into 40 cases each group (interrupted X suture) and (continuous suture) they were randomized into two groups depending on whether the patient registration number was odd or even. Results: The age of the patients varied from 16 years to 82 years. In Group A, the mean age was 36.75 ± 13.78 years, and in Group B, the mean age of the patients was 38.37 ± 12.56 years. In Group A, 8 (20%) patients had comorbidity, whereas, in Group B, 10 (25%) patients had comorbidity. In Group A, 12 patients had wound infection, while in Group B, ten patients had wound infection (P = 0.001 [statistically significant]). In Group A, two patients had wound dehiscence, while none of the patients in Group B had wound dehiscence (P = 0.001 [statistically significant]). There was no incisional hernia in both the groups. Conclusion: Emergency laparotomy is associated with a higher rate of burst abdomen as compared to elective laparotomy, but using interrupted X suture technique in sheath closure, wound dehiscence can be prevented up to some extent.

COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

2018 ◽  
Author(s):  
Anil Pandey ◽  
Setul Shah ◽  
Deepak S Maravi ◽  
S Uikey
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Proximal Tibia ◽  
Plate Fixation ◽  
Surgical Site Infections ◽  
Delayed Union ◽  
Large Sample Size ◽  
Multicentric Study ◽  
Group A ◽  
Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary  nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended   Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

scholarly journals ACUTE CHOLECYSTITIS

2010 ◽  
Vol 17 (02) ◽  
pp. 185-192
Author(s):  
TARIQ HASSAN CH ◽  
ASGHAR ALI ◽  
MUNAWAR JAMIL
Keyword(s):  
Hospital Stay ◽  
Wound Dehiscence ◽  
Biliary Tree ◽  
Postoperative Hospital Stay ◽  
Total Hospital ◽  
Acute Calculous Cholecystitis ◽  
Total Hospital Stay ◽  
Group A ◽  
The Mean ◽  
Group B

Introduction: Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. Objective: To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Setting: Department of Surgery Bahawal Victoria Hospital Bahawalpur. Duration of Study: Two year study from December 2007 to December 2009. Subject and Methods: Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by intervalcholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. Results: The mean age of the patients in group A was 42.2 + 10.7 years and in group B was 42.2+ 10.7 years. The Male to female ratio was 1:4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1.8days and in group B was 3.8+ 1.4 days. The mean total hospital stayin group A was 6.5 + 1.7 days and in group B was 10.2 + 1.3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1(3.3%) injury to biliary tree, 4(13.3%) wound infection,1(3.3%) wound haematoma, 3 (10%) seroma and 1(3.3%) wound dehiscence. While in group B there were 1(3.3%) injury to biliary tree, 3(10%) wound infection,2 (6.7%) wound haematoma, 2(6.7%) & no patient of wound dehiscence. Conclusion: Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery.

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