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 Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

2017 ◽  
Vol 4 (8) ◽  
pp. 2534
Author(s):  
Nicolo Tamini ◽  
Marco Cereda ◽  
Giulia Capelli ◽  
Alessandro Giani ◽  
Luca Gianotti
Keyword(s):  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Abdominal Wall ◽  
Data Retrieval ◽  
Fascial Closure ◽  
Skin Closure ◽  
Absorbable Suture ◽  
Site Infection ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy

Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

scholarly journals Diagnosis and treatment of anterior abdominal wall ligature fistulas

2016 ◽  
Vol 97 (2) ◽  
pp. 204-207 ◽  
Author(s):  
A G Izmaylov ◽  
S V Dobrokvashin ◽  
D E Volkov ◽  
V A Pyrkov ◽  
R F Zakirov ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Comparison Group ◽  
Anterior Abdominal Wall ◽  
Abdominal Cavity ◽  
Main Group ◽  
Wound Complications ◽  
Control Group ◽  
Absorbable Suture ◽  
Wound Debridement ◽  
Complications Rate

AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.

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 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 ◽  
2019 ◽  
Vol 20 (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.

Early Fascial Closure of the Damage Control Abdomen in Children

2010 ◽  
Vol 76 (5) ◽  
pp. 497-501 ◽  
Author(s):  
Myrick C. Shinall ◽  
Kaushik Mukherjee ◽  
Harold N. Lovvorn
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Damage Control ◽  
Necrotizing Pancreatitis ◽  
Abdominal Wall Reconstruction ◽  
Acellular Dermal Matrix ◽  
Fascial Closure ◽  
Time Range ◽  
Dermal Matrix ◽  
Abdominal Closure

Traditional staged closure of the damage control abdomen frequently results in a ventral hernia, need for delayed abdominal wall reconstruction, and risk of multiple complications. We examined the potential benefits in children of early fascial closure of the damage control abdomen using human acellular dermal matrix (HADM). We reviewed our experience with five consecutive children sustaining intra-abdominal catastrophe and managed with damage control celiotomy. To accomplish early definitive abdominal closure, HADM was sewn in place as a fascial substitute; the skin and subcutaneous layers were approximated over silicone drains. The five patients ranged in age from 1 month to 19 years at the time of presentation. Intra-abdominal catastrophes included complex bowel injuries after blunt trauma in two children, necrotizing pancreatitis and gastric perforation in one teenager, necrotizing enterocolitis in one premature infant, and perforated typhlitis in one adolescent. All damage control wounds were dirty. Time range from initial celiotomy to definitive abdominal closure was 6 to 9 days. After definitive closure, one child developed a superficial wound infection. No patient developed a ventral hernia. After damage control celiotomy in children, early abdominal wall closure using HADM may minimize complications associated with delayed closure techniques and the need for additional procedures.

scholarly journals Open abdomen management: single institution experience

2015 ◽  
Vol 42 (2) ◽  
pp. 93-96 ◽  
Author(s):  
Adilson Costa Rodrigues Junior ◽  
Fernando da Costa Ferreira Novo ◽  
Rafael de Castro Santana Arouca ◽  
Francisco de Salles Collet e Silva ◽  
Edna Frasson de Souza Montero ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Statistical Significance ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Abdominal Closure ◽  
The Difference ◽  
Mean Time ◽  
De Medicina

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure

scholarly journals The results of surgical treatment of patients with large and complex incisional hernias of the anterior abdominal wall in a multidisciplinary hospital

2018 ◽  
Vol 17 (3) ◽  
pp. 35-44 ◽  
Author(s):  
E. N. Degovtsov ◽  
P. V. Kolyadko ◽  
V. P. Kolyadko ◽  
A. V. Satinov
Keyword(s):  
Surgical Treatment ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Incisional Hernia Repair ◽  
The Body ◽  
Wound Complications ◽  
Postoperative Wound ◽  
Mesh Reinforcement

Objectives. To evaluate the immediate results of surgical treatment of patients with large incisional hernia of the anterior abdominal wall with the use of the mesh implants.Materials and methods. The data were retrospectively collected and analyzed. The study included patients with a large and / or complex incisional hernia. There were 108 patients who underwent incisional hernia repair with mesh reinforcement in the period from 2012 to 2016. In all cases the repairs were made with mesh implants. The average age of patients was (56.4 ± 10.4) years. The body mass index (BMI) was on average (32.6 ± 6.24) kg/m2. The medial localization of the hernia was 102 (94.44%). The width of the hernia defect averaged (12.2 ± 3.7) cm. Implants were placement in onlay positions – 19 (17.6%), sublay – 49 (45.37%), IPOM (Intraperitoneal onlay mesh) – 30 (27.77%) patients, the component separation technique (CST) with mesh reinforcement was used in 10 (9.25%) patients. Active aspiration drainage was performed in 72 (66.66%) patients.Results. The average time for draining the postoperative wound was (5 ± 2.2) days. The number of wound complications was 23 (21.3%), the number of seromas of the postoperative wound prevailed was 16 (14.8%) patients, of which 2 (1.85%) were chronic abdominal wall seromas, hematoma occurred in  2 patients (1.85%), the number of prolonged serous exudation was 7 (6.5%), necrosis of the wound edges occurred in 4 (3.7%) patients. There was no mortality. Reliably more often wound complications occurred in patients with large hernia defects (p = 0.006), and also with an increase in the duration of surgical intervention (p = 0.01). The hospital-stay in patients with complications was significantly greater (p < 0.001), the need for analgesics also increased (p < 0.001).Conclusion. Prevention of wound complications after large and complex incisional hernia repair with mesh reinforcement is an important direction in improving the results of surgical treatment in this category of patients.

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