COMPARATIVE STUDY BETWEEN MASS CLOSURE AND LAYERED CLOSURE OF MIDLINE ABDOMINAL INCISIONS AT DMCH, LAHERIASARAI, BIHAR

2021 ◽  
pp. 6-8
Author(s):  
Ravindra Kumar Ravi ◽  
Vijay Shankar Prasad ◽  
Debarshi Jana
Keyword(s):  
Incisional Hernia ◽  
Single Layer ◽  
Wound Dehiscence ◽  
Closure Technique ◽  
Burst Abdomen ◽  
True Incidence ◽  
Mass Closure ◽  
Time Required ◽  
Closure Group

Background: Traditionally, a laparotomy wound is closed in layers co-opting the various layers anatomically. A new method of closure, namely single layer closure technique (mass closure technique) has come into vogue. Aims: This study aims to evaluate the benets or otherwise between single layer closure and layered closure after comparing it with studies available in literature. Settings and Design : This study was conducted at Upgraded Department of Surgery, DMCH, Laheriasarai, Bihar, in patients undergoing laparotomy, either planned or emergency. Materials and Methods: A total of 80 cases were selected at random and the study was carried out over a period of 2 years. The cases were equally divided into two groups of 40. In both groups, vertical midline incision was used. In the rst group, abdomen was closed using the single layer closure technique. Continuous suturing with burial of the knots was done in 20 patients and interrupted mass closure was done in another 20 patients. In the other group, the abdomen was closed in layers. The patients were followed up for minimum 6 months. Patients who did not turn up for follow up were asked to notify the development of any wound complication through postal correspondence. Results: The time required for closure was considerably less when continuous suture technique was used. One patient in the mass closure group and four in the layered group developed post-operative wound infections. One patient in the layered closure group developed a stitch sinus. There were two cases of burst abdomen with the layered closure technique. Two patients in the layered closure group developed incisional hernias 6 months post-operatively. Conclusions: Single layer closure technique offers certain denite advantage over the layered closure technique with respect to the time required for closure of the incision, incidence of wound dehiscence and the incidence of incisional hernia. However, the true incidence of wound dehiscence (burst abdomen) and incisional hernia cannot be drawn since the study was of short duration and the number of cases was small without a long follow up.

scholarly journals P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Thomas Korgaard Jensen ◽  
Ismail Gögenur ◽  
Mai-Britt Tolstrup
Keyword(s):  
Incisional Hernia ◽  
High Rate ◽  
Fascial Closure ◽  
Closure Technique ◽  
Burst Abdomen ◽  
Incisional Hernias ◽  
Mass Closure ◽  
Long Term Effect

Abstract Aim This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients. Material and Methods A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias. Results 94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%. Conclusions Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.

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.

Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

2012 ◽  
Vol 78 (8) ◽  
pp. 864-869 ◽  
Author(s):  
William S. Cobb ◽  
Alfredo M. Carbonell ◽  
Garrett M. Snipes ◽  
Brianna Knott ◽  
Viet Le ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Incisional Hernia ◽  
Operative Time ◽  
Group Versus ◽  
True Incidence ◽  
Hernia Formation ◽  
The Mean ◽  
Laparoscopic Techniques ◽  
Mean Time

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m2; P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

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.

Layered versus Mass Closure of Vertical Midline Laparotomy Wounds in Negro Africans

1988 ◽  
Vol 18 (2) ◽  
pp. 67-69 ◽  
Author(s):  
Spencer E E Efem ◽  
Akuma Aja
Keyword(s):  
Incisional Hernia ◽  
Infection Rates ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Ancestry Group ◽  
Keloid Formation ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

A prospective comparative study of layered closure versus mass closure of vertical midline laparotomy incisions was undertaken in 314 consecutive patients of indigenous Negroid ancestry. Group A (109 patients) had mass closure and group B (205 patients) had layered closure. The patients were similar in both groups. Group A consisted of 49 (45%) emergencies and 60 (55%) elective cases, and group B of 93 (45%) emergencies and 112 (55%) elective cases. There were 6 cases of burst abdomen and 4 cases of incisional hernia in group B; group A suffered no wound failure. The wound infection rates were 3.7% for group A and 10% for group B. Mass closure carries lower wound failure rates than layered closure of laparotomy wounds, and polyamide sutures do not increase keloid formation in Negro patients.

scholarly journals O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
René Fortelny ◽  
Markus Albertsmeier ◽  
Anna Hofmann ◽  
Stefan Riedl ◽  
Jan Ludolf Kewer ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Controlled Trial ◽  
Cox Proportional Hazards Model ◽  
Published Data ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Short Stitch ◽  
To Receive ◽  
Incisional Hernia Rate

Abstract Aim The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®). Material and Methods Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy. Results 425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142). Conclusions Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.

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 Surgical treatment of subcostal incisional hernia with polypropylene mesh - analysis of late results

2014 ◽  
Vol 41 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Marco Antonio de Oliveira Peres ◽  
Herberti Rosique Aguiar ◽  
Nelson Adami Andreollo
Keyword(s):  
Surgical Treatment ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Polypropylene Mesh ◽  
Wound Dehiscence ◽  
Incisional Hernia Repair ◽  
Late Results ◽  
Late Complications ◽  
Technical Failure

OBJECTIVE: To evaluate the results of subcostal incisional hernia repair using polypropylene mesh, the technical aspects of musculo-aponeurotic reconstruction, routine fixation of supra-aponeurotic mesh and follow-up for five years.METHODS: We conducted a retrospective study that assessed 24 patients undergoing subcostal incisional hernia repair with use of polypropylene mesh; 15 patients (62.5%) were female; ages ranged from 33 to 82, and 79.1% had comorbidities.RESULTS: Early complications: three cases (12.5%) of wound infection, three cases (12.5%) of seroma, one case (4.1%) of hematoma; and one case (4.1%) of wound dehiscence. Late complications occurred in one case (4.1%) of hernia recurrence attributed to technical failure in the fixation of the mesh and in one case (4.1%) of chronic pain. There were no cases of exposure or rejection of the mesh.CONCLUSION: The subcostal incisional hernia, though not very relevant, requires adequate surgical treatment. Its surgical correction involves rebuilding the muscle-aponeurotic defect, supra-aponeurotic fixation of polypropylene mesh, with less complexity and lower rates of complications and recurrences.

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 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.

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