Evaluation of the results of midline laparotomy closure in emergency surgery after the introduction of the fascial closure with small bites technique

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.

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Difference Between Delayed Anastomosis and Early Anastomosis in Damage Control Laparotomy Affecting the Infusion Volume and NPWT Output volume: Is Infusion Restriction Necessary in Delayed Anastomosis? A Single-Center Retrospective Analysis

10.21203/rs.3.rs-772713/v1 ◽

2021 ◽

Author(s):

Yohta Tanahashi ◽

Hisaho Sato ◽

Akiko Kawakami ◽

Shusaku Sasaki ◽

Yu nishinari ◽

...

Keyword(s):

Retrospective Analysis ◽

Emergency Surgery ◽

Damage Control ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Artificial Anus ◽

Single Center ◽

Damage Control Laparotomy ◽

Second Look ◽

Output Volume

Abstract Background: Delayed anastomosis is a treatment strategy used in damage control laparotomy (DCL). During temporary abdominal closure (TAC) with DCL, infusion volume, and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure (PFC). The same may also hold true for anastomosis. The aim of this research is to evaluate whether the difference between early anastomosis and delayed anastomosis in DCL is related to infusion volume and NPWT output volume.Methods: This single-center retrospective analysis targeted patients managed with TAC during emergency surgery for trauma or intra-abdominal sepsis between January 2011 and December 2019. It included patients who underwent repair/anastomosis/artificial anus construction in the first surgery and patients who underwent intestinal resection in the first surgery followed by delayed anastomosis with no intestinal continuity. The main outcomes were infusion volume, NPWT output volume and complications.Results: One hundred nine patients who underwent emergency surgery were evaluated. Seventy-three patients were managed with TAC using NPWT. In 16 patients with early anastomosis and 21 patients with delayed anastomosis, there was no difference in the infusion volume (p=0.2318) or NPWT output volume (p=0.7128) 48 hours after surgery. Additionally, there was no difference in the occurrence of surgical site infection (p=0.315) and suture failure (p=0.8428). During the second-look surgery after 48 hours, the anastomosis was further postponed for 48% of the patients who underwent delayed anastomosis. There was no difference in the infusion volume (p=0.0783) up to the second-look surgery between the patients whose delayed anastomosis was postponed and those who underwent delayed anastomosis, but there was a tendency toward a large NPWT output volume (p=0.024) in the postponed delayed anastomosis group. Anastomosis and PFC were achieved for all patients whose delayed anastomosis was postponed.Conclusions: The presence or absence of anastomosis during TAC management does not affect NPWT output volume. Delayed anastomosis may be managed with the same infusion volume as that used for early anastomosis. There is also the option of postponing anastomosis if the planned delayed anastomosis is complicated.Trial RegistrationThe retrospective protocol of this study was approved by our institutional review board (MH2018-611).

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Prevention of Incisional Hernia in Ovarian Cancer Patients Undergoing Midline Laparotomy

10.21203/rs.3.rs-1020551/v1 ◽

2021 ◽

Author(s):

Berta Fabregó Capdevila ◽

Ester Miralpeix ◽

Josep-Maria Solé-Sedeño ◽

José-Antonio Pereira ◽

Gemma Mancebo

Keyword(s):

Ovarian Cancer ◽

Social Impact ◽

Statistical Significance ◽

Fascial Closure ◽

Borderline Ovarian Tumor ◽

Mesh Group ◽

Midline Laparotomy ◽

Mesh Placement ◽

The Social

Abstract BACKGROUND: Incisional hernias (IH) are a frequent complication of midline laparotomies in abdominal surgery. This study was conducted in order to determine the efficacy of mesh placement and assess the optimal fascia closure technique to reduce the IH rate in patients surgically treated after being diagnosed with malignant or borderline ovarian tumors.METHODS: Retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer in Hospital del Mar, Barcelona, from January 2008 to December 2019 were collected. Patient demographic, preoperative and intraoperative characteristics and risk factors for hernia were reported. The incidence of IH between groups (mesh and non-mesh) and the technique used in fascial closure for each patient (small bites technique vs large tissue bites) was reported. RESULTS: In total, 133 patients with available data for follow-up were included. After clinical and radiological examination, 25 (18.79%) of them showed IH. 18 of 61(29.5%) patients in non-mesh group developed IH, compared with 7 of 72 (9.7%) in mesh group (OR 0.25, 95% CI 0.09-0.66, p<0.005). Patients of large tissue bites group showed higher prevalence of IH compared with small bites technique group without statistical significance (OR 0.46, 95% CI 0.17-1.24, p=0.119). The combination of mesh reinforcement and small bites technique for fascial closure significantly reduce IH risk (p=0.021). CONCLUSION: Incidence of IH is high in patients undergoing midline laparotomy for ovarian cancer or borderline ovarian tumor. The addition of a prophylactic mesh and use of small bites technique may reduce the incidence of IH and potentially minimize the social impact and costs of this complication.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20172403 ◽

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.

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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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Reinforced tension line suture closure after midline laparotomy in emergency surgery

Tropical Doctor ◽

10.1258/td.2011.110045 ◽

2011 ◽

Vol 41 (4) ◽

pp. 193-196 ◽

Cited By ~ 8

Author(s):

Akhilesh Agarwal ◽

Zahid Hossain ◽

Anshu Agarwal ◽

Amitabha Das ◽

Saurav Chakraborty ◽

...

Keyword(s):

Emergency Surgery ◽

Midline Laparotomy ◽

Suture Closure

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

Updates in Surgery ◽

10.1007/s13304-021-01125-0 ◽

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.

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Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

10.21203/rs.2.13713/v1 ◽

2019 ◽

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 incisional hernia rates are reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia rates, 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 small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in 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 whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the rate of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

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The impact of different suturing techniques for abdominal fascia closure on the Interleukin-6 expressions in Rattus norvegicus

BMC Research Notes ◽

10.1186/s13104-020-05349-y ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Heryu Prima ◽

Imam Sofii ◽

Aditya Rifqi Fauzi ◽

Ishandono Dachlan ◽

Gunadi

Keyword(s):

Incisional Hernia ◽

Important Determinant ◽

Healing Process ◽

Fascial Closure ◽

Wound Healing Process ◽

Midline Laparotomy ◽

Abdominal Fascia ◽

Suturing Techniques ◽

The Impact ◽

Fascia Closure

Abstract Objective Incisional hernia is a frequent complication of midline laparotomy. The suturing technique is an important determinant of the risk of developing an incisional hernia. Moreover, IL-6 has crucial roles in the wound-healing process. We aimed to compare the large stitch vs. small stitch technique for abdominal fascial closure on IL-6 expressions in rats. Results Twenty rats were used. The small stitch group received small tissue bites of 5 mm and the large stitch group received large bites of 10 mm. The incisions of fascia were closed by running sutures. Animals were euthanized on days 4 and 7. Histological sections of the tissue-embedded sutures were analyzed for IL-6 expressions. Two-way ANOVA showed that rats in the small stitch group had similar IL-6 expressions on days 4 and 7 to those in the large stitch group (p = 0.36). In conclusion, the IL-6 expressions are similar between the small and the large stitch groups, implying that different suturing techniques might not have an impact on the incisional hernia occurrence.

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