scholarly journals Experience of small tissue bites with conventional tissue bites in emergency setting for midline abdominal wound closure

2022 ◽  
Author(s):  
Varun Dogra ◽  
Silvi Sandhu ◽  
Ishfaq Ahmad Gilkar ◽  
Shyam Gupta
Keyword(s):  
Wound Closure ◽  
Abdominal Cavity ◽  
Emergency Setting ◽  
Abdominal Wound ◽  
Site Infection ◽  
Midline Incision ◽  
Midline Laparotomy ◽  
Small Tissue ◽  
Group I ◽  
Group Ii

Background: Midline incision provides excellent access to the abdominal cavity. However, wound infection following a laparotomy can increase morbidity as well as burden on health care system. Wound prognosis can be influenced by the type of incisions, suture material and the method of closure. This study aimed to assess the outcome of midline abdominal wound closure using two different techniques of wound closure.Methods: This was a prospective observational study and consisted of 300 consecutive patients ≥18 years of age undergoing abdominal surgery through a midline incision in emergency setting. Patients who were included in the study were then randomised into two groups. In group I, midline laparotomy was closed with large tissue bites and in group II small tissue bites were used.Results: Out of 300 patients included in this study, 150 patients were subjected to large tissue bites and another 150 patients to small tissue bites. 29 patients out of 150 patients (19%) in large tissue bites group and 16 patients (11%) in small tissue bites developed surgical site infection (SSI). 23 patients out of 50 patients (15%) in large tissue bites group and 11 patients (7%) in small tissue bites developed wound dehiscence.Conclusions: In this study, we found that the patients in group II whose midline laprotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

Compare the Incidence of Surgical Site Infection after Appendectomy Wound Irrigation with Normal Saline and Imipenem Solutions

2021 ◽  
Vol 15 (8) ◽  
pp. 2184-2186
Author(s):  
Ahmad Shah ◽  
Nazeer Ahmad Sasoli ◽  
Farrukh Sami
Keyword(s):  
Surgical Site Infection ◽  
Wound Infection ◽  
Saline Solution ◽  
Abscess Formation ◽  
Site Infection ◽  
Wound Irrigation ◽  
Group I ◽  
Perforated Appendix ◽  
The Mean ◽  
Group Ii

Objective: To compare the incidence of surgical site infection after appendectomy wound irrigation with regular saline solution and imipenem solution. Study Design: Comparative randomized control trial Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st September 2020 to 30th April 2021. Methodology: Eighty patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. Patients underwent for appendectomy wound irrigation were included. Patients were equally divided into two equal groups, I and II. Group I had 40 patients and received imipenem and group II irrigated with saline solution with 40 patients. Outcomes were surgical site infection, deep abscess formation was observed post-operatively. Results: The mean age of the patients in group I was 26.11±2.03 years with mean BMI 23.61±3.32 kg/m2 and in group II mean age was 25.14±3.12 years with mean BMI 22.14±4.88 kg/m2. In group I, 32 (80%) patients had inflamed appendix, perforated appendix was in 7 (17.5%) and gangrenous appendix in 1 (2.5%) while in group II inflamed appendix in 34 (85%), perforated appendix in 4 (10%) and gangrenous appendix 2 (5%). Surgical site infection in group I was 3 (7.5%) and abscess formation in 2 (5%) cases while in group II SSI in 6 (15%) and abscess formation in 3 (7.5%) cases. Conclusion: Imipenem irrigation after appendectomy reduces wound infection. Healthcare costs and patient suffering due to infection can be reduced. Keywords: Imipenem solution, Wound irrigation with saline, Appendectomy wound infection

Evaluation of the effectiveness of vacuum-assisted closure in the treatment of Fournier gangrene

2021 ◽  
pp. 1
Keyword(s):  
Hospital Stay ◽  
Wound Closure ◽  
Length Of Hospital Stay ◽  
Vacuum Assisted Closure ◽  
Analgesic Requirement ◽  
Vac Therapy ◽  
Fournier Gangrene ◽  
Group I ◽  
Group Ii ◽  
Closure Method

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

scholarly journals Assessment of risk factors for surgical site infection following caesarean section

2019 ◽  
Vol 8 (11) ◽  
pp. 4518
Author(s):  
Aditi Sangwan ◽  
Vani Malhotra
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Emergency Caesarean ◽  
Group I ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Wound Discharge ◽  
Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

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 Outcome of Abdominal Wound Closure Following Continuous and Interrupted Suture in Elective Laparotomy

2014 ◽  
Vol 8 (2) ◽  
pp. 73-76 ◽  
Author(s):  
Md Mazedur Rahman ◽  
Abdus Samad Azad ◽  
Muhammad Golam Mawla ◽  
Meer Mahbubul Alam ◽  
Md Mushfiqur Rahman
Keyword(s):  
Wound Infection ◽  
Wound Closure ◽  
Abdominal Wound ◽  
Continuous Suture ◽  
Interrupted Suture ◽  
Wound Pain ◽  
Suture Group ◽  
Group Ii ◽  
The Difference ◽  
Clean Contaminated

Closure is a crucial factor in laparotomy wound. Fascial layers provide the major tensile strength in wound closure. Poor wound healing and development of wound infection in incisional wounds are the common complications of open abdominal surgery. Continuous fascial closure commonly practiced and the interrupted closures are also practiced by some surgeon with an assumption that it causes less pain and less wound infection. The aim of this study was to determine the rate of postoperative wound infection and severity of wound pain following interrupted and continuous abdominal wound closure. A comparative cross-sectional study was done at the Department of surgery, Sylhet MAG Osmani Medical College Hospital from 1st July 2007 to 30th June 2008. A total 100 patients of clean-contaminated elective laparotomy were selected. The patients were randomly divided into two groups. Every odds number was included in group-I (interrupted suture) and every even number was included in group-II (continuous suture). Total 14% wound infection was detected in interrupted suture group where as wound infection was 18% in continuous suture group of wound closure. Though the wound infection is higher in group-II but the difference of wound infection is not statistically significant between two groups. The wound pain assessed in seven postoperative days was higher in continuous closure group than interrupted group but the difference was not significant. There is no significant difference of wound infection and wound pain between interrupted and continuous suture group in clean-contaminated laparotomy. DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20373 Faridpur Med. Coll. J. 2013;8(2): 73-76

scholarly journals DIAGNOSTICS AND TREATMENT OF PERFORATED PYLORODUODENUM ULCERS IN WOMEN

2016 ◽  
Vol 175 (2) ◽  
pp. 98-100
Author(s):  
A. G. Khasanov ◽  
M. B. Galin ◽  
F. F. Badretdinova ◽  
M. A. Nurtdinov ◽  
R. Kh. Shaikhinurov
Keyword(s):  
Wound Closure ◽  
Abdominal Cavity ◽  
Age Groups ◽  
Long Term Results ◽  
Perforated Ulcer ◽  
Elderly Age ◽  
Midline Laparotomy ◽  
Early Postoperative Complications ◽  
Results Of Treatment

The results of treatment of 75 women with perforated ulcers have been studied. There were prevailed women of middle and elderly age groups among patients who underwent surgery. A wound closure of perforated opening and abdominal sanation were performed by laparoscopic means in 30,7% of patients and using midline laparotomy in 29,3% cases. There were carried out the laparoscopic sanation of the abdominal cavity and the wound closure of perforated ulcer from mini-access using the set of mini-assistant in 10,7% patients. Radical operations were applied in 16% cases. The early postoperative complications took place in 8,1% of the patients, the rate of lethality was 4,0%. The long-term results were evaluated and considered as good in 55,5% women, satisfactory - in 30,1% and unsatisfactory - in 14,2% cases.

scholarly journals Comparison of non-absorbable (polypropylene) versus delayed absorbable (polydioxanone) suture material for abdominal wound closure after laparotomy

2018 ◽  
Vol 5 (5) ◽  
pp. 1690 ◽  
Author(s):  
Deepti Pai ◽  
Rajgopal Shenoy ◽  
Chethan K.
Keyword(s):  
Surgical Site Infection ◽  
Wound Closure ◽  
Suture Material ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Site Infection ◽  
Suture Materials ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Background: Type of suture material used for fascial closure in laparotomies influences the incidence of post-operative complications. Currently there is no consensus on the superiority of either absorbable or non-absorbable suture materials for abdominal fascial closure. Aim of this study was to determine the superior suture material for abdominal wall closure after elective laparotomy among polypropylene and polydioxanone based on the occurrence of specific post-operative complications.Methods: A prospective observational study was conducted at Kasturba hospital, Manipal from September 2014 to August 2016. Patients admitted under General surgery, who underwent midline laparotomy were included in the study. Polydioxanone and Polypropylene suture materials were used for mass closure and post-operative complications were compared.Results: Hundred patients were included. The two study groups (Prolene and Polydioxanone) were homogenous, with no significant difference between age, BMI, co-morbidities and indication for surgery. Surgical site infection was significantly more in prolene group (p=0.031). Duration of surgeries was longer in prolene group (p=0.020), hence, a subgroup analysis was done and only surgeries under 4-hour duration were analysed. It showed no difference between the two groups with respect to surgical site infection (p=0.320). There was no significant difference between the two groups in burst abdomen and incisional hernia.Conclusions: There was no significant difference between Prolene and Polydioxanone when early and late post-operative complications were compared. Hence, either of the two suture materials can be used for abdominal wound closure in elective midline laparotomies.

Compare the Outcomes of Laparoscopic and Open Appendectomy

2021 ◽  
Vol 15 (7) ◽  
pp. 1742-1744
Author(s):  
Aqeel Ahmad ◽  
Muhammad Hammad Muzaffar ◽  
Mumtaz Ahmad Khan ◽  
Arshid Mahmood
Keyword(s):  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Site Infection ◽  
Time Duration ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Aim: The aim of this study is to compare the surgical site infection, hospital stay and time duration of procedure in patients undergoing laparoscopic and open appendectomy. Study Design: Prospective/ Observational Place & Duration: Department of Surgery, Pak Red Crescent Medical and Dental college, Dina Nath, during from Jan 2020 to March 2021. Methods: In this study 240 patients of both genders with ages >10 years presented with acute appendicitis were included. Patients demographic including age, sex and body mass index were recorded after written consent. Patients were equally divided into two groups. Group I consist of 120 patients and received laparoscopic appendectomy and Group II with 120 patients received open appendectomy. Outcomes such as surgical site infection, hospital stay and time duration of procedure were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. P-value <0.05 was set as significant. Results: There were 140 (58.3%) patients (70 Group I, 70 Group II) were male with mean age 25.7+6.54 years while 100 (41.7%) patients (50 Group I, 50 Group II) were females with mean age 26.9+3.12 years. No significant difference regarding BMI between both groups p=>0.05. There was a significant difference in term of surgery time duration between both groups 48.24+9.59 minutes Vs 35.74+6.86 minutes; P=0.001. No significant difference observed in term of hospital stay (p=0.345). 11 (9.2%) patients in Group II in which 5.83% had Superficial SSI and 3.7% had Deep SSI. 9 (7.5%) patients 5% superficial and 2.5% Deep SSI in Group I had developed surgical site infection with no significant difference (p=0.41). Conclusion: We concluded in this study that open appendectomy is better in term of operative time as compared to laparoscopic appendectomy. We found no significant difference regarding surgical site infection and hospital stay. Keywords: Acute appendicitis, Appendectomy, Laparoscopic, Open, Outcomes

Comparison of Laparotomy Wound Dehiscence (LWD) Rate Using Interrupted X-Suture Technique vs Continuous Suture Technique in Rectus Sheath in Emergency Laparotomy

1969 ◽  
Vol 11 (3) ◽  
pp. 133-136
Author(s):  
Fazli Akbar ◽  
Muhammad Khan ◽  
Nisar Ahmad ◽  
Shah Abbas ◽  
Nadeem Khan
Keyword(s):  
Rectus Sheath ◽  
Wound Dehiscence ◽  
Suture Technique ◽  
P Value ◽  
Emergency Laparotomy ◽  
Continuous Suture ◽  
Midline Laparotomy ◽  
Group I ◽  
Laparotomy Wound ◽  
Group Ii

Background: Emergency laparotomy is one of the most commonly performed surgeries in emergency situations of generalsurgery department. This can be performed for multiple causes. Wound closure is one of the main component of outcomes of thissurgery. Some surgeons prefer continuous closure ofthe linea Alba while other prefer interrupted closure technique.Objective: To compare the frequency of laparotomywound dehiscence (LWD) using continuous suture technique with interruptedX-suture technique inrectus sheath for emergency laparotomy wound closure.Materials & Methods: This randomized controlled trial was conducted on adult patients who were planned for emergency midlinelaparotomy in the department of general surgery of Saidu Group of Teaching Hospitals, Swat. The study was conducted fromJanuary 2019 to November 2019. We included 200 patients and divided them into two equal groups. Group I; In these patients,abdominal incision was closed using continuous suture technique.Group II; inthese patients, interrupted X-suture technique wasused for closure of abdominal wound incision. Patients were evaluated daily for 7 days and after that, at 15, h day, to diagnose thewound dehiscence on clinical evaluation.Results:Mean age was 43.8 ± 8.7 years in group I and42.6 ± 10.9 years in groupII(p-value 0.39). There were 77%male patients ingroup I and 74% in group II (p-value 0.74). Peritonitis due to gut perforation was the commonest etiology, with 63% proportion ingroup I versus 68% in group II (p-value 0.55). Laparotomy wound dehiscence was diagnosed in 15% patients in group I versus3.0% patients in group II (p-value 0.006).Conclusion: Interrupted X-suture technique is better than continuous suture technique for abdominal wall closure afteremergency midline laparotomy.Interrupted X-suture technique has significantly loweredthe frequency of wound dehiscence.Keywords:Acute abdomen, emergency midline laparotomy,laparotomy wound dehiscence.

INTRAPERITONEAL ALLOPLASTY COMBINED WITH THE ANTERIOR COMPONENT SEPARATION TECHNIQUE IN GIANT INCISIONAL HERNIAS

2018 ◽  
Vol 91 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Orest Lerchuk ◽  
Ia. P. Feleshtynskyi ◽  
V.V. Smishchuk ◽  
V. F. Vatamaniuk ◽  
S. A. Svyrydovskyi
Keyword(s):  
Surgical Treatment ◽  
Surgical Site Infection ◽  
Abdominal Wall ◽  
Site Infection ◽  
Incisional Hernias ◽  
Group I ◽  
Onlay Technique ◽  
Chronic Postsurgical Pain ◽  
Group Ii ◽  
Wall Components

The use of the anterior technique of the abdominal wall components separation combined with ‘onlay’ aloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of the surgical site complications. In our view, the use of intra-abdominal aloplasty combined with the anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH. Purpose: to improve the results of surgical treatment of giant IH by the use of ACST + IPOM. Materials and methods. Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 years (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into 2 groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. Results and discussion. As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. Conclusions. IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during the surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal volume of abdominal cavity without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. A reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.

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