Open VS Closed Techniques for Laparoscopic Abdominal Surgeries

Background: Laparoscopic surgery or "minimally invasive" surgery is a type of specialist surgery. The most crucial, demanding, and risky part of the laparoscopy is the creation of pneumoperitoneum. The two most prevalent methods for creating a pneumoperitoneum are the closed and open approaches. Despite the fact that there is no universal consensus on the best approach to gain access to the peritoneal cavity in order to create a pneumoperitoneum. The aim of present study was to compare the operative time and post-operative outcome associated with closed technique and open classic technique. Methods: This randomized controlled trial was carried out by recruiting patients presented in surgery department of Ziauddin Hospital North campus. The samples were divided into two equal groups A and B. Group A was operated for Laparascopic abdominal surgery by open technique while group B operated through closed technique. Effectiveness of procedures was measured by number of complications occurred during and after surgery. Chi-square test and independent T-test were applied for association. P-value of < 0.05 was considered as significant. Results: Mean age was found to be 45.5±16 years and mean weight was 68±10.5 kilograms. Mean time of operations was 84.5±18.5 minutes. 60 (69.8%) of patients included underwent the laparoscopic cholecystectomy while 15 (17.4%) patients had laparoscopic appendectomy. 13/86: 15.1% of patients had the minor complication including 12/43: 27.9% in group B and 1/43: 2.3% in group A. The comparative analysis between the two groups in terms of effectiveness of either method compared by means of development of the complications was found to be highly significant with p value 0.002. Conclusion: The open approach to laparoscopic entrance has been linked to fewer surgical problems than the closed approach.

Comparison of two Different Surgical Modalities in the treatment of Pilonidal Sinus (Primary Closure and Open Technique)

Background: Pilonidal sinus is disease of young age andits prevalence is higher in men compared to women (almost twice).It is a disease that arises from hair follicles particularly present in the natal cleft. It occurs commonly in Jeep Drivers and hence gets the name from there “Jeep Drivers Disease” and also commonly occurs in Barbers. It leads to formation of abscesses and chronic wounds with discharge and pain. Disease can have huge impact on social life and quality of life. In most cases the treatment is incision and drainage. Study design: It is a case series study. Place and duration of study: Department of General Surgery at Shaikh Zayed Hospital Lahore from January 2019 to January 2021. Aim: To compare the relative effects of open and closed surgical techniques on the recurrence rate, rate of infection and time of healing for pilonidal sinus. Methodology: Patients with pilonidal sinus disease from January 2019 to January 2021 received surgical treatment either excision followed by primary closure as in closed technique (group A) or excision followed by leaving the wound open for healing by secondary intention as in open technique (group B). Surgical management is widely based upon two techniques open and closed. In open technique wound is left open and heals by secondary intention while in closed technique it is closed primarily and heals by primary intention. The better choice between these two techniques is still a topic of debate. Results: The most common age group for pilonidal sinus was between 16-25 years of age. The mean age came out to be 26.7 years. The mean healing time was 15 days in group A and 42 days in group B. The duration of hospital stay ranged between 2-8 days for group A and 5-16 days for group B. Early postoperative complications seen was infection in 1 patient (7.69%) in group A and 5 patients (35.71%) in group B and these cases were managed conservatively.1 (7.69%) case of aseptic gaping of wound after stitch removal was seen in group A and was managed with closed technique. Recurrences reported in group A was 1 case (7.69%) at 6 months and was surgically managed by open technique. There were a total of 4 (28.57%) recurrences which were left open to heal by granulation. Conclusion: It is concluded that better management option for pilonidal sinus disease is primary closure of defect. So it is suggested that management of pilonidal sinus disease should be individualized but preference must be given to closure of wound after excision. Keywords: Pilonidal sinus, Primary Closure, Open Technique.

Periodontal results of different therapeutic approaches (open vs. closed technique) and timing evaluation ( 2 year) of palatal impacted canines: a systematic review

Background This review evaluates, as a primary outcome, which surgical technique (open vs. closed) and which type of material used for the auxiliaries (elastic vs. metallic) were preferable in terms of periodontal results during the treatment of palatal-impacted canines. The timing of the evaluation of the results was also assessed as a secondary outcome. Methods An electronic search of the literature up to March 2021 was performed on Pubmed, MEDLINE (via Pubmed), EMBASE (via Ovid), Cochrane Reviews and Cochrane Register of Controlled Trials (RCTs) (CENTRAL). The risk of bias evaluation was performed using version 2 of the Cochrane risk of bias tool (RoB 2) for RCTs and the ACROBAT NRSI tool of Cochrane for non-RCTs. Results 11 articles met the inclusion criteria. Only one RCT was assessed as having a low risk of bias and all the non-RCTs were assessed as having a serious risk of bias. This review revealed better periodontal results for the closed technique and metallic auxiliaries. In addition, it revealed that the timing of the evaluation of the results affects the periodontal results with better results obtained 2 years after the end of treatment. Conclusion In the treatment of a palatal-impacted canine, the closed technique and metallic auxiliaries should be preferred in terms of better periodontal results. The timing of the evaluation of the results affects the periodontal results.

A comparative study of the open versus closed method of pneumoperitoneum creation in laparoscopic surgery

Background: The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure and associated with many complications including life threading vascular and visceral injuries. Techniques for the creation of pneumoperitoneum in laparoscopy include the standard technique of insufflation after insertion of the Veress needle (closed method), open laparoscopy (Hasson technique) and many others.Methods: This is observational study conducted in the department of General surgery, PDUMC, Rajkot from September 2018 to September 2020 comprising of 100 cases, 50 cases from each methods. The patients admitted in our department for Laparoscopic surgery was taken up for the study. The Purpose of our study is to assess the practicality of both methods in creation of pneumoperitoneum and to compare both methods with regards to ease of performance and incidence of complications.Results: Average size of incision (p=-5.426) is more in open method, hence more incidence of minor complications like multiple attempts, gas leak at port site and port site bleeding in open method while less duration for creating pneumoperitoneum (p=0) as compared to closed method. While there is no major complications in either groups.Conclusions: Open technique is as good as closed technique, and is good alternative to closed technique.

Comparative Study between Open Surgical Drainage and Closed Technique of Percutaneous Aspiration under Image Guidance for Management of Breast Abscess

Background: The conventional surgical management of breast abscesses consists of an incision taken over the point at which there is maximum fluctuation (or pain) and breaking of the abscess septa by digits. Now antibiotics and repeated abscess aspiration under USG guidance is new minimally invasive method which is on rise Objectives: To study the outcome of open technique of breast abscess management. To study the outcome of closed technique of breast abscess management. To compare the outcome of open v/s closed technique of surgical management of breast abscess. Methodology: Sample will be divided into two groups and type of treatment i.e open incision and drainage or percutaneous aspiration under guidance will be decided randomly by chit system. Expected Results: Feasibility and outcome of Percutaneous drainage is better than incision and drainage Conclusion: First line management of Breast abscess will soon be percutaneous drainage under USG guidance.

Palatally displaced and impacted canines – What is taught during postgraduate orthodontics training in Europe?

Objectives: One of the most challenging orthodontic treatments is displaced and impacted canines palatally displaced canines (PDC/PIC). The aim of this study was, therefore, to assess what postgraduate students are taught about PDC and PIC during their postgraduate orthodontic training (POT) in Europe. Materials and Methods: A digital survey containing 22 questions was sent to 164 POT programs in 28 European countries. Questions were asked about which interceptive and surgical treatments are taught, the advantages of different surgical procedures, and what dressing materials and X-rays are used for PIC therapy planning. Reminders were sent 4 times. Results: About 43% (71 POT programs) responded. Extraction of deciduous canines (76%) was the most favored interceptive treatment. A closed technique with a gingival margin flap and a gold plated chain was the most commonly taught surgical technique (69%), even though both open and closed exposure of PICs were performed in 54 postgraduate programs. Coe-Pak™ with sutures was one of the preferred dressing materials in open exposure. Active treatment was started before the canine erupted, that is, spontaneous eruption of the tooth following open exposure was not awaited by 1/3 of the respondents and 1/3 left the question unanswered. Closed exposure was more often preferred than open exposure for post-surgical, periodontal, and esthetic reasons. The most common radiographs before surgery were panoramic and intraoral radiographs. Cone-beam computed tomography was taken by half of the respondents when resorption of adjacent teeth was suspected. Conclusion: Extraction of deciduous canines as an interceptive approach to PDC and closed exposure of PIC were taught in most of the POT programs.

A PROSPECTIVE STUDY OF OPEN VERSUS CLOSED LATERAL INTERNAL SPHINCTEROTOMY IN CHRONIC ANAL FISSURES

Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Objective: This prospective study compared the results and complications of open versus closed technique of lateral sphincterotomy in patients with chronic anal ssure. Materials and Methods:Atotal of 64 patients with chronic anal ssure were enrolled in this study. Of these, 34 patients underwent open lateral sphincterotomy, and 30 underwent closed sphincterotomy. They were followed up for 6 months postsurgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to atus were signicantly lesser in the closed group (P < 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: Closed lateral internal sphincterotomy is a better alternative compared to open sphincterotomy in the treatment of chronic anal ssures.