MANAGEMENT AND OUTCOME OF ABDOMINAL WALL CLOSURE IN EMERGENCY LAPAROTOMY AT A TERTIARY CARE CENTRE

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Mohit Badgurjar ◽  
Poojan Thakor ◽  
Pankaj Saxena ◽  
Suman Parihar ◽  
Giriraj Prajapati ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Tertiary Care ◽  
Wound Complications ◽  
Emergency Laparotomy ◽  
Abdominal Wall Closure ◽  
Suture Materials ◽  
Tertiary Care Centre ◽  
Mass Closure ◽  
Continuous Methods ◽  
Closure Group

Objective: Abdominal wall closure of an emergency laparotomy involves a great deal of consideration. An ideal laparotomy wound closure should be efficient. provide strength and serve as a barrier to infection. The aim of this study is to compare and evaluate the advantages of layered closure in comparison with the mass layered closure, the types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia. Methods: This prospective study was carried out over a period of 18 months enrolling a total of 90 patients split into two groups with group 1 undergoing mass closure using both interrupted and continuous methods and group 2 undergoing layered closure using both interrupted and continuous methods of suturing. Results: A higher rate of wound complications was noted in the layered closure group (37.7%) than the mass closure group (17%). Wound complications were also noted to be higher in closures done with prolene suture (37.7%) than PDS (20%). As far as techniques were concerned, interrupted and continuous suturing had a similar rate of complications. Of all the comorbidities, considered in the study, the highest rate of wound related complications were seen in patients with pulmonary complications (13.3%). Conclusion: Although the ideal way to close an abdomen post laparotomy has not yet been discovered, our study shows that mass closure with PDS suture to close the abdominal wall should be advocated as there is decreased early and late post operative wound complications Keywords: PDS.

scholarly journals A comparative study of single layer closure versus conventional layered closure of laparotomy wounds

2018 ◽  
Vol 5 (4) ◽  
pp. 1459
Author(s):  
Akash Bande ◽  
Divish Saxena ◽  
Prabhat B. Nichkaode ◽  
Murtaza Akhtar
Keyword(s):  
Abdominal Wall ◽  
Tertiary Care ◽  
Single Layer ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Linea Alba ◽  
Mass Closure ◽  
Interrupted Suture ◽  
Closure Group ◽  
Better Than

Background: The goal of wound closure after laparotomy is to restore the function of the abdominal wall. The techniques for closure of anterior abdominal wall includes either layered closure, modified Smead-Jones technique, mass closure or retention suture or combination of above mentioned techniques. The studies which compared the continuous and interrupted suture techniques have concluded that enmass continuous sutures have an advantage of holding the fascia together. The present study tries to compare the two techniques i.e. single layer closure (mass closure) and layered closure in patients undergoing laparotomy by midline incision in tertiary care hospital.Methods: 97 patients undergoing either emergency or elective midline laparotomy were included in the study, where in 64 patients laparotomy closure was done in single layer using polypropylene 1-0 and in 33 patients by layered closure where peritoneum was closed with polygalactin 2-0 and linea alba by polypropylene 1-0. Patients were allocated two groups as per convenience of operating surgeon without using any method of randomization.Results: The single layer closure technique required statistically significant less closure time of 18.2±3.2 minutes as compared to conventional layered closure 26.4±4 minutes time of (p <0.001). Also, the incidence of postoperative complications was found to be comparatively less (17.18%) in single layer closure group as compared to complications (42.42%) in layered closure group.Conclusions: Single layer closure technique continues to be better than conventional layered closure technique of laparotomy wounds in terms of operative time and post-operative complications.

scholarly journals A comparative study of two different techniques of subcutaneous tissue closure in abdominal surgery

2017 ◽  
Vol 6 (12) ◽  
pp. 5512
Author(s):  
Jyotsna S. Dwivedi ◽  
Alka S. Gupta ◽  
Sachin H. Pardeshi
Keyword(s):  
Subcutaneous Tissue ◽  
Tertiary Care ◽  
Total Duration ◽  
Wound Complications ◽  
Control Group ◽  
Tertiary Care Centre ◽  
Surgical Access ◽  
Suction Drain ◽  
The Difference

Background: Surgical access to abdomen is required for many operative procedures. The subcutaneous tissue of the anterior abdominal wall can either be sutured or left unsutured with drain in situ. The purpose of this study was to compare the two methods of closure of the subcutaneous tissue and determine the benefit of one over the other.Methods: The study was conducted in a tertiary care centre with sample size of 30 each in study and control group. Patients fulfilling the inclusion criteria were selected and depending on the randomisation the closure of subcutaneous tissue was done either by polyglactin 910, 2-0 or left unsutured with indigenously designed syringe suction drain kept in situ. The patients were followed up till the day of suture removal and further in case of any complications.Results: Total duration taken for the procedure was significantly increased in the study group. There was a significant level of discomfort among the participants due to drain. The rate of surgical site infection, hospital readmission morbidity was significantly higher in the study group.Conclusions: The type of drain studied was indigenously designed where the closed system was not maintained during charging the drain, hence further studies need to be conducted which will compare this with the other closed suction drains to determine the difference in the risk of wound complications.

scholarly journals Technique of Midline Abdominal Incision Closure Among Surgical Trainees

2020 ◽  
Vol 17 (2) ◽  
pp. 72-75
Author(s):  
Alex Muturi ◽  
Kotecha Vihar ◽  
Pulei Ann ◽  
Maseghe Philip
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Tertiary Hospital ◽  
Fascial Closure ◽  
Wound Complications ◽  
Absorbable Suture ◽  
Abdominal Wall Closure ◽  
Abdominal Incision ◽  
Abdominal Closure ◽  
Surgical Trainees

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used. Methods: A descriptive study was carried out from October 2015 to May 2016. Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds. Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital. Keywords: Abdominal closure, Midline incision, Wound complications

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 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.

scholarly journals Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

2018 ◽  
Vol 5 (4) ◽  
pp. 1368
Author(s):  
G. V. Manoharan ◽  
T. Sivakumar ◽  
M. Ashok Kumar
Keyword(s):  
Hospital Stay ◽  
Abdominal Wall ◽  
Subcutaneous Tissue ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Skin Closure ◽  
Abdominal Wall Closure ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay. 

scholarly journals A STUDY ON LAYERED CLOSURE VERSUS MASS CLOSURE OF LAPAROTOMY INCISIONS

2021 ◽  
pp. 48-49
Author(s):  
Therani Dorababu ◽  
Kumaran R
Keyword(s):  
Wound Closure ◽  
Tertiary Care ◽  
Late Complications ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Laparotomy Wound ◽  
Ideal Method ◽  
Closure Group ◽  
The Ideal

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 while preventing both early and late complications. Present study is undertaken to compare the two methods (LAYERED closure and MASS closure) of laparotomy wound closure in relation to postoperative complications,time for wound closure in both groups and also to decide the most effective method among the two. Methods: This study was conducted in department of surgery at a tertiary care teaching hospital at KANCHIPURAM (TAMILNADU) from DECEMBER 2019 to DECEMBER 2020. On admission,patients suspected of having intraabdominal pathology,a thorough clinical examination 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 of late complications. Results:Total 60 patients of were studied.Majority of patients were in 66 -75 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. Conclusions: Mass closure technique is less time consuming,safe for closure of midline laparotomy incisions.

scholarly journals A comparative study of two layer versus three-layer repair of mediolateral episiotomy

2020 ◽  
Vol 9 (8) ◽  
pp. 3412
Author(s):  
Manasi V. Gaikwad ◽  
M. Vijaya Sree ◽  
Swapnil V. Bobde
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Wound Complications ◽  
Layer Versus ◽  
Care Hospital ◽  
Suture Materials ◽  
Mediolateral Episiotomy ◽  
Significant Difference

Background: Since majority of the women attending study hospital are belonging to lower socioeconomic strata and active involvement of paramedical staff in providing obstetric care, this study was undertaken to find the utility of a two-layer repair of mediolateral episiotomy and compare it with the standard method of closure in relation to its simplicity, cost-effectiveness and superiority if any, over the traditional three-layered repair of episiotomy.Methods: This was a prospective interventional study comparing 100 women who underwent two-layer closure with 100 women who underwent three-layer closure of episiotomy in a tertiary care hospital in Pune, India over a period of 2 years from October 2012 to October 2014. The parameters assessed were operative time, number of suture materials required, immediate post procedure pain and complications at follow-up. Qualitative and quantitative data was analysed using unpaired t-test, chi square test and Fisher exact test.Results: Both the groups were comparable in terms of hospital stay and wound complications such as oedema, dehiscence, hematoma, requirement of resuturing, cosmesis and long-term complications such as dyspareunia. However, two-layer repair required less operative time, lesser number of suture materials and decreased pain during hospital stay as there was statistically significant difference observed between the two groups.Conclusions: In this study experience, it can be concluded that two-layer repair of episiotomy is faster, with less post-operative pain and more cost effective. Hence it provides mother with better services.

A PROSPECTIVE STUDY OF PREDICTORS FOR POST LAPAROTOMY ABDOMINAL WOUND DEHISCENCE

2021 ◽  
pp. 54-58
Author(s):  
Sajib Chatterjee ◽  
Basanta Banerjee ◽  
Asis Kumar Saha ◽  
Maitreyee Mukherjee ◽  
Saugata Samanta
Keyword(s):  
Tertiary Care ◽  
Wound Dehiscence ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Care Hospital ◽  
Abdominal Wound ◽  
Tertiary Care Centre ◽  
Antimicrobial Drugs ◽  
Contaminated Wound ◽  
Abdominal Wound Dehiscence

Introduction: Wound dehiscence or burst abdomen is a very serious post-operative complication which is associated with high morbidity and mortality rates. Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques- post-operative wound dehiscence continues to be a major threat. Aims And Objectives: 1. To nd the incidence of abdominal wound dehiscence following laparotomy in a tertiary care centre of Eastern India. 2. To evaluate the factors implicated and their contribution in abdominal wound dehiscence Methodology: This prospective single centre observational study was conducted at a tertiary care hospital on 100consenting patients undergoing both elective and emergency laparotomy..All the cases were followed up on postoperative days 1, 4, 7 and 10 or till discharge and further follow up was continued every 2 weeks till 4 weeks . Patients with wound dehiscence were evaluated by the investigators for the enlisted parameters which were ,age sex; BMI; comorbidities like anemia. hypoproteinemia; hypertension.jaundice,increased urea creatinine ,habit of smoking;presence of clean or contaminated wound and various other factors like time of surgery,use of steroids,ASA physical status and so on. Results: We found that wound dehiscence was signicantly more in male patients;patients with increased BMI,presence of anemia, hypoproteinemia, increased serum urea creatinine level. It was more in contaminated wound and patients with higher ASA physical status.But time taken for surgery type of surgery has no inuence on wound dehiscence in this study. Conclusion: Post laprotomy wound dehiscence depends on multiple factors.

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