Comparison of Laparotomy Wound Dehiscence (LWD) Rate Using Interrupted X-Suture Technique vs Continuous Suture Technique in Rectus Sheath in Emergency Laparotomy

Background: Emergency laparotomy is one of the most commonly performed surgeries in emergency situations of generalsurgery department. This can be performed for multiple causes. Wound closure is one of the main component of outcomes of thissurgery. Some surgeons prefer continuous closure ofthe linea Alba while other prefer interrupted closure technique.Objective: To compare the frequency of laparotomywound dehiscence (LWD) using continuous suture technique with interruptedX-suture technique inrectus sheath for emergency laparotomy wound closure.Materials & Methods: This randomized controlled trial was conducted on adult patients who were planned for emergency midlinelaparotomy in the department of general surgery of Saidu Group of Teaching Hospitals, Swat. The study was conducted fromJanuary 2019 to November 2019. We included 200 patients and divided them into two equal groups. Group I; In these patients,abdominal incision was closed using continuous suture technique.Group II; inthese patients, interrupted X-suture technique wasused for closure of abdominal wound incision. Patients were evaluated daily for 7 days and after that, at 15, h day, to diagnose thewound dehiscence on clinical evaluation.Results:Mean age was 43.8 ± 8.7 years in group I and42.6 ± 10.9 years in groupII(p-value 0.39). There were 77%male patients ingroup I and 74% in group II (p-value 0.74). Peritonitis due to gut perforation was the commonest etiology, with 63% proportion ingroup I versus 68% in group II (p-value 0.55). Laparotomy wound dehiscence was diagnosed in 15% patients in group I versus3.0% patients in group II (p-value 0.006).Conclusion: Interrupted X-suture technique is better than continuous suture technique for abdominal wall closure afteremergency midline laparotomy.Interrupted X-suture technique has significantly loweredthe frequency of wound dehiscence.Keywords:Acute abdomen, emergency midline laparotomy,laparotomy wound dehiscence.

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Comparison of suture technique (interrupted vs. continuous) with respect to wound dehiscence

Indian Journal of Medical Sciences ◽

10.25259/ijms_21_2020 ◽

2020 ◽

Vol 72 ◽

pp. 191-194

Author(s):

Gopal Sharma ◽

Nivedita Prashar ◽

Nikita Gandotra

Keyword(s):

Wound Infection ◽

Wound Dehiscence ◽

Suture Technique ◽

Emergency Laparotomy ◽

High Morbidity ◽

Continuous Suture ◽

Midline Laparotomy ◽

Group A ◽

The Mean ◽

Group B

Objectives: Post-operative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today. The quest for the best closure technique for abdominal incisions continues. To achieve this goal, several modifications in opening the abdomen and closing the wound have been tried. There are many studies in the literature comparing various methods of wound closure, with conflicting results. The aim of the present study was to assess the proportion of wound infection and wound dehiscence in the post-midline laparotomy patients, using interrupted X suture versus continuous suture technique in sheath closure. Material and Methods: A total of 80 patients undergoing vertical midline emergency laparotomy at one of the gynecology units were recruited randomly after taking written informed consent and were equally divided into 40 cases each group (interrupted X suture) and (continuous suture) they were randomized into two groups depending on whether the patient registration number was odd or even. Results: The age of the patients varied from 16 years to 82 years. In Group A, the mean age was 36.75 ± 13.78 years, and in Group B, the mean age of the patients was 38.37 ± 12.56 years. In Group A, 8 (20%) patients had comorbidity, whereas, in Group B, 10 (25%) patients had comorbidity. In Group A, 12 patients had wound infection, while in Group B, ten patients had wound infection (P = 0.001 [statistically significant]). In Group A, two patients had wound dehiscence, while none of the patients in Group B had wound dehiscence (P = 0.001 [statistically significant]). There was no incisional hernia in both the groups. Conclusion: Emergency laparotomy is associated with a higher rate of burst abdomen as compared to elective laparotomy, but using interrupted X suture technique in sheath closure, wound dehiscence can be prevented up to some extent.

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A comparative study between continuous and x-interrupted sutures in emergency midline laparotomies

International Surgery Journal ◽

10.18203/2349-2902.isj20181437 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1753

Author(s):

Shashikala V. ◽

Abhilash S. B. ◽

Abhishek G. ◽

Prajwal S. Fernandes

Keyword(s):

Suture Material ◽

Rectus Sheath ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Midline Laparotomy ◽

Group A ◽

Common Technique ◽

Laparotomy Wound ◽

Group B ◽

Time Required

Background: Midline laparotomy is the most common technique of abdominal incisions in both emergency and elective settings. Wound dehiscence is related to several factors pertaining to patient besides suture material and method of closure. This study tries to compare continuous sutures with x-interrupted sutures in mass closure of midline laparotomy wound in patients undergoing emergency midline laparotomy for acute peritonitis.Methods: A total of 60 patients undergoing emergency midline laparotomy for secondary peritonitis were considered for the study, 30 of whom underwent closure of abdominal wall with continuous sutures (Group A) and the other 30 with x-interrupted sutures (Group B) using non-absorbable, monofilament, polypropylene suture. Necessary preoperative data, the time required for rectus closure, length of the suture material required, post-operative complications like surgical site infection, wound dehiscence were analyzed.Results: The groups were comparable in means of age and sex distribution. Group A was found to have lesser time for closure of rectus, lesser suture length and lesser suture to wound length ratio when compared with Group B. Surgical site infections were similar in both groups. Patients with rectus sheath sutured in x-interrupted sutures (n=2) had significantly less wound dehiscence as compared with continuous sutures (n=8) (p<0.05).Conclusions: Interrupted -X suture method of suturing reduces post-operative wound dehiscence, although requires more suture and consumes more time than the continuous method of suturing.

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Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Trauma Image and Procedure ◽

10.24184/tip.2021.6.1.22 ◽

2021 ◽

Vol 6 (1) ◽

pp. 22-24

Author(s):

Da Yeon Lee ◽

Pil Young Jung

Keyword(s):

Wound Healing ◽

Case Report ◽

Wound Dehiscence ◽

Cost Effective ◽

Suture Technique ◽

Surgical Wound ◽

Midline Laparotomy ◽

Surgical Wound Dehiscence ◽

Surgical Incisions ◽

Laparotomy Wound

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.

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Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20190819 ◽

2019 ◽

Vol 6 (3) ◽

pp. 886

Author(s):

Rajesh Kumar Bansiwal ◽

Tarun Mittal ◽

Rajeev Sharma ◽

Sanjay Gupta ◽

Simrandeep Singh ◽

...

Keyword(s):

Rectus Sheath ◽

Wound Dehiscence ◽

Fascial Closure ◽

Emergency Laparotomy ◽

Abdominal Wound ◽

Midline Laparotomy ◽

Medical College ◽

Group A ◽

Abdominal Wound Dehiscence ◽

Group B

Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.

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Comparison of Outcome of Lateral Pinning Versus Medial and Lateral Cross Pinning in Childhood Supracondylar Fractures of Humerus

10.53350/pjmhs211592873 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2873-2875

Author(s):

Mudassar Nazzar ◽

Muhammad Adeel-Ur- Rehman ◽

Rizwan Anwar ◽

Omer Farooq Tanveer ◽

Muhammad Abdul Hanan ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Functional Outcomes ◽

P Value ◽

Supracondylar Fractures ◽

Group I ◽

Pin Fixation ◽

Group Ii ◽

Carrying Angle ◽

Ulnar Nerve Injury

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

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Comparison of Adverse Outcomes in Cirrhotic and Non-Cirrhotic Patients with Covid-19 Disease

10.53350/pjmhs211572289 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2289-2291

Author(s):

Jahangir Anjum ◽

Talal Safdar ◽

Muhammad Imran ◽

Muazzam Fuaad ◽

Waheed Iqbal ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Teaching Hospital ◽

Adverse Outcomes ◽

Chronic Liver ◽

P Value ◽

Group I ◽

Cirrhotic Patients ◽

Group Ii ◽

Disease Study

Objective: The aim of this study is to determine the comparison of adverse outcomes in cirrhotic and non-cirrhotic patients presented with coronavirus disease. Study Design: Place and Duration: The department of Medicine of Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from October 2020 to March 2021. Methodology: Total 80covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were aged between 20-55 years. Patients were divided in to two groups. Group I (with cirrhosis 40 patients) and group II (without cirrhosis 40 patients). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 26.0 version. Results: There were 24 (60%) males and 16 (40%) were females with mean age 44.19±7.65 years in group I while in group II 27 (67.5%) and 13 (32.5%) patients were males and females with mean age 43.62±5.34 years. We found that mortality rate among patients of group I (cirrhotic) had high mortality rate13 (32.5%) as compared to patients without cirrhosis 5 (12.5%) in group II with p-value 0.0003. Conclusion: We concluded in this that frequency of adverse outcomes was significantly high among cirrhotic patients with coronavirus disease as compared to non-cirrhotic patients. Keywords: Corvid-19, Mortality, Chronic Liver Disease

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Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i3.36951 ◽

2018 ◽

Vol 41 (3) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Madhabi Baidya ◽

Mahfuza Shirin ◽

Liton Chandra Saha

Keyword(s):

Perinatal Asphyxia ◽

Care Center ◽

Tertiary Care ◽

Preterm Neonates ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Neonatal Transport ◽

Group I ◽

Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

10.21203/rs.3.rs-1121729/v1 ◽

2021 ◽

Author(s):

Shivkumar Gopalakrishnan ◽

sangeetha kandasamy ◽

S.Malini ◽

S.Peer Mohamed ◽

k.velmurugan

Keyword(s):

Inflammatory Markers ◽

Severe Disease ◽

Radiation Hazard ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Group Iii ◽

Group I ◽

Group Ii ◽

D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

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Results of modern tuboperitoneal infertility treatment

Vojnosanitetski pregled ◽

10.2298/vsp0901057t ◽

2009 ◽

Vol 66 (1) ◽

pp. 57-62 ◽

Cited By ~ 1

Author(s):

Drenka Turjacanin-Pantelic ◽

Dragana Bojovic-Jovic ◽

Biljana Arsic ◽

Eliana Garalejic

Keyword(s):

Statistical Analysis ◽

Surgical Treatment ◽

Infertility Treatment ◽

P Value ◽

Modern Approach ◽

Vitro Fertilization ◽

Group I ◽

Significant Difference ◽

Group Ii

Background/Aim. A modern approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy. Methods. A retrospectiveprospective study on 66 women treated operatively form tuboperitoneal infertility was performed. Data from patient's anamnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. Results. Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.4%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. Conclusion. Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.

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Vocabulary performance of students with and without difficulties learning to read and write

Revista CEFAC ◽

10.1590/1982-0216/202123312020 ◽

2021 ◽

Vol 23 (3) ◽

Author(s):

Cláudia da Silva ◽

Patrícia do Valle Alves

Keyword(s):

Data Analysis ◽

First Grade ◽

Musical Instruments ◽

P Value ◽

Language Test ◽

Learning To Read ◽

Substitution Process ◽

Group I ◽

Group Ii ◽

Lexical Competence

ABSTRACT Purpose: to compare vocabulary performances and verify the lexical competence of students with and without difficulties learning to read and write. Methods: 93 first-grade students were divided into Group I (50 students without difficulties) and Group II (43 students with difficulties learning to read and write). They were administered the Child Language Test focusing on vocabulary. The analysis considered aspects of usual word designation, non-designation, and substitution process. The data analysis was conducted with the Mann-Whitney test, with a p-value ≤ 0.05. Results: there were significant performances in the comparison between the groups in all the conceptual fields analyzed. There was no significance for either group regarding the conceptual fields of Foods, Furniture and Appliances, Places, and Professions in non-designation; regarding Means of Transportation in substitution processes; regarding Toys and Musical Instruments in both non-designation and substitution processes. Group I had higher means than Group II in usual word designation, and lower ones in non-designation and substitution processes. Conclusion: students with difficulties learning to read and write had greater difficulties in usual word designation, as well as higher error indexes in substitution processes and non-designation, which reveals a deficient vocabulary concerning lexical access in comparison with students without difficulties.

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