Two cases of delayed surgical site infection after reconstruction of the abdominal wall by using a composite mesh

Background: This is a prospective non randomized observational comparative study for surgical site infections and surgical site occurrences after laparotomy fascia closer with two different techniques. Regular bite remains the standard of care in most hospitals. Laparotomies were done for elective and emergency cases.Methods: There were two techniques used to close abdominal wall fascia. The present study has evaluated small bite abdominal closer verses regular bite closer. Author and his team had used small bite fascia closer technique for all laparotomies, while other group of surgeons utilized regular bite fascia closer.Results: Out of 26 laparotomies in short bite closer, 8 had surgical site infections and surgical site occurrences, while 26 laparotomies in regular bite closer group had 15 patients with surgical site infections and surgical site occurrences. There is significant reduction in surgical site infection and surgical site occurrences observed in small bite abdominal closer group.Conclusions: It is recommended all laparotomies elective or emergent should be closed with small bite technique as it reduces surgical site infections and surgical site occurrences.

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Use of the Mobile Post-Operative Wound Evaluator in the Management of Deep Surgical Site Infection after Abdominal Wall Reconstruction

Surgical Infections Case Reports ◽

10.1089/crsi.2017.0022 ◽

2017 ◽

Vol 2 (1) ◽

pp. 80-84 ◽

Cited By ~ 3

Author(s):

Ravi F. Sood ◽

Andrew S. Wright ◽

Heidi Nilsen ◽

JoAnne D. Whitney ◽

William B. Lober ◽

...

Keyword(s):

Surgical Site Infection ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Site Infection ◽

Deep Surgical Site Infection ◽

Operative Wound

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Increased incidence of surgical site infection with a body mass index ≥ 35 kg/m2 following abdominal wall reconstruction with open component separation

Surgical Endoscopy ◽

10.1007/s00464-018-6538-9 ◽

2018 ◽

Vol 33 (8) ◽

pp. 2503-2507 ◽

Cited By ~ 6

Author(s):

Salvatore Docimo ◽

Konstantinos Spaniolas ◽

Michael Svestka ◽

Andrew T. Bates ◽

Samer Sbayi ◽

...

Keyword(s):

Body Mass Index ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Body Mass ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Site Infection

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Complex Abdominal Wall Reconstruction in Neutropenic Patients

The American Surgeon ◽

10.1177/00031348211011086 ◽

2021 ◽

pp. 000313482110110

Author(s):

Kajmolli Agon ◽

Smiley Abbas ◽

McGuirk Matthew ◽

Gachabayov Mahir ◽

Bodin Roxana ◽

...

Keyword(s):

Surgical Site Infection ◽

Abdominal Wall ◽

Fatty Liver Disease ◽

Abdominal Wall Reconstruction ◽

Case Series ◽

Transversus Abdominis ◽

Site Infection ◽

Transversus Abdominis Release ◽

Nonalcoholic Fatty Liver ◽

Neutropenic Patients

The aim of our study was to determine whether patients with neutropenia (absolute neutrophil count (ANC) ≤1,500 cells/µL) had higher rates of surgical site infection after elective abdominal wall reconstruction. This was a case series from a prospective complex abdominal wall reconstruction cohort describing the surgical outcomes of 4 neutropenic patients (ANC ≤1,500 cells/µL) within 48 hours of index operation. Median age was 55 years, 3 patients were female. All patients had liver cirrhosis as a comorbidity: 2 patients as a result of alcohol abuse and 2 patients secondary to cryptogenic and nonalcoholic fatty liver disease, respectively. All patients underwent a posterior component separation with transversus abdominis release and retro-rectus biologic mesh. None of the 4 patients developed a surgical site infection 90 days postoperatively. Complex abdominal wall reconstruction in neutropenic patients could be safe.

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Comparing Surgical Site Infection for Open and Endoscopic Component Separation

The American Surgeon ◽

10.1177/000313481908500423 ◽

2019 ◽

Vol 85 (4) ◽

pp. 350-352

Author(s):

Derek S. Palmer ◽

Conner C. Mcdaniel ◽

Navdeep S. Samra ◽

F. Dean Griffen

Keyword(s):

Quality Improvement ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Infection Rate ◽

Meta Analysis ◽

Abdominal Wall Hernia ◽

Component Separation ◽

Separation Technique ◽

P Value ◽

Site Infection

In March 2016, we reported the SSI rate at LSU Health for all abdominal wall hernia repairs performed between 2011 and 2013. Among the 263 repairs, the infection rate averaged 6.8 per cent. Given the diversity of repairs, this global percentage lacks relevance, but looking at subsets provides meaningful insights. For example, SSI was 1.8 per cent among 55/263 laparoscopic repairs and 8.2 per cent among 206/263 open repairs. The infection rate of 26.3 per cent among the 19 open component separation cases was especially noteworthy and bothersome. Even though there was no mortality in any subset, the vast majority of the morbidity and costs involved repairs with open component separations. A meta-analysis published in 2016 revealed a likely SSI benefit for the endoscopic component separation technique (ECST) over the open CST. Since that report, we have focused our quality improvement efforts on this subset of challenging cases and have replaced CST with ECST. Our data now include results from 33 hernia repairs with either CSTor ECST that were performed between November 2011 and April 2018. Twenty-four of 33 patients had CSTwith an SSI rate of 37.5 per cent (9 of 24). Nine of 33 had ECST with 0 per cent SSI (P value = 0.039). These results mirror the findings reported in the meta-analysis.

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The Impact of Mesh Reinforcement with Components Separation for Abdominal Wall Reconstruction

The American Surgeon ◽

10.1177/000313481808400648 ◽

2018 ◽

Vol 84 (6) ◽

pp. 959-962 ◽

Cited By ~ 3

Author(s):

Seyed Amirhossein Razavi ◽

Karan A. Desai ◽

Alexandra M. Hart ◽

Peter W. Thompson ◽

Albert Losken

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Recurrence Rate ◽

Abdominal Wall Reconstruction ◽

Abdominal Hernia ◽

Fascial Closure ◽

Site Infection ◽

Components Separation ◽

The Impact

The goal in abdominal wall reconstruction (AWR) is to minimize morbidity and prevent hernia recurrence. Components separation and mesh reconstruction are two options, however, with advantages and disadvantages. The purpose of this review was to investigate outcomes in patients with abdominal wall hernia undergoing primary closure with component separation (CS) versus CS with acellular dermal matrix (ADM) reinforcement (CS + mesh). Medical records of consecutive patients who underwent abdominal wall reconstruction using CS with or without ADM reinforcement were retrospectively reviewed. Primary fascial closure was achieved in all patients. ADM reinforcement when used was performed using the underlay technique. Reconstructive technique and postoperative complications including delayed healing, skin necrosis, fistula, seroma, hematoma and surgical site infection, recurrence, and reoperation were recorded. Comparisons between the two groups were assessed. One hundred and seven patients were included (mean age, 55.7; 51.4% male; median follow-up 297 days). Twenty-six patients (24%) underwent CS alone; whereas 81 patients (76%) CS + mesh placement. Patient comorbidities, including smoking (26%), diabetes (20%), and hypertension (46%); body mass index (mean 32.3 ± 7.6); and albumin level on the day of surgery (mean 3.4 ± 0.5 mg/dL) were not significantly different between groups. Surgical site infection was significantly higher among CS + mesh patients (22.2%) versus CS only patients (3.9%) (P = 0.02). The recurrence rate of abdominal hernia was significantly lower in CS + mesh patients compared with CS only (14.8% vs 34.6%; P = 0.02). No significant differences in other postoperative complications were identified between the two groups. ADM reinforcement at the time of components separation is often selected in more complex, higher risk patients. Although the incidence of infection was higher in these patients, it was usually treated without mesh removal and recurrence rate was significantly lower when compared to CS alone.

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Abdominal Wall Thickness: Is It Associated with Superficial and Deep Incisional Surgical Site Infection after Colorectal Surgery?

Surgical Infections ◽

10.1089/sur.2012.109 ◽

2013 ◽

Vol 14 (4) ◽

pp. 363-368 ◽

Cited By ~ 10

Author(s):

Mary R. Kwaan ◽

Anne Marie E. Sirany ◽

David A. Rothenberger ◽

Robert D. Madoff

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Wall Thickness ◽

Site Infection ◽

Incisional Surgical Site Infection

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A prospective study in peritonitis patients to compare the impact of subcutaneous negative suction closure, conventional primary closure of skin and subcutaneous tissue and open skin technique following laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20194068 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3293

Author(s):

Mano Zac Mathews ◽

Sriram Gopalakrishnaiah Subramanyam ◽

Nivedita Mitta

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Abdominal Wall ◽

Subcutaneous Tissue ◽

Site Infection ◽

Abdominal Wall Closure ◽

Suction Drain ◽

Group A ◽

Group B ◽

Negative Suction

Background: Abdominal wall closure in the presence of sepsis presents a challenge to the surgeon. The objective of this study is to determine the advantages and disadvantages of each method to individualise the techniques based on patient profile about surgical site infection, duration of hospitalisation and morbidity.Methods: A prospective comparative study was conducted among 102 operated patients of peritonitis in the Department of General Surgery at St John’s Medical College and Hospital. The patients were divided into three groups, group A, group B and group C. In group A, skin and subcutaneous tissue was closed after draining the subcutaneous space by a negative-suction drain. In group B, the patient’s skin and subcutaneous tissues were closed primarily with continuous sutures without negative suction drain. In group C, the laparotomy wound was closed and the skin was left open. And the outcome compared in the form of wound infection, hospital stay and morbidity. Patients on immunosuppressive therapy and paediatric patients were excluded. Demographic and clinical variables were recorded at the time of admission. SPSS version 18 was used for analysis.Results: The study showed male preponderance and the mean age was 43.2 years. Duodenal perforation was the commonest cause of peritonitis in this study (38.2%). Incidence of surgical site infection was less in Group A (20.6%) compared to group B (52.9%) and group C (29.4%). Duration of hospital stay was also less in Group A patients (9.3±3.6 days) compared to other two groups. 37 patients who were included in the study were diabetic, out of which 25 patients (67.6%) developed surgical site infection.Conclusions: It can be concluded from this study that abdominal wall closure using a sub cutaneous negative suction drain in peritonitis cases reduces the incidence of surgical site infection, duration of hospital stays, subsequent surgeries related to wound dehiscence and its associated morbidity.

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