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

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.

Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.

A STUDY ON LAYERED CLOSURE VERSUS MASS CLOSURE OF LAPAROTOMY INCISIONS

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.

Experimental study on an alternative to suturing the laparotomy wound with a mesh thread

BACKGROUND: Incisional ventral hernias (IVH) in abdominal surgery remain relevant because the frequency of their formation after laparotomy reaches 10%30.7%. AIM: This study aimed to develop a method for the primary closure of a laparotomy wound via mesh endoprosthesis, which is superior to laparorrhaphy with traditional suture materials in terms of morphophysical properties. MATERIALS AND METHODS: Laparorrhaphy with a mesh thread was developed (Patent for invention RUS No 2714439 02/14/2020) as an alternative to preventive prosthetics with narrow indications to avoid herniation. An experimental work was conducted to investigate the wound process in the suture area on days 14 and 60 and determine the effectiveness and safety of the proposed method. RESULTS: Video laparoscopy data showed that no cases of adhesions were observed between the internal organs and the area of laparorrhaphy on days 14 and 60 of the postoperative period. Defects in the area of the application of sutures on the aponeurosis of the white line were absent. In the wound, the mesh thread fully integrated into the regenerating tissue, including at the site of the knot. The tissue also grew through the meshed cells. On day 14, the strength of the regenerating tissue with the sutured mesh thread was greater than that sutured without it (11.198 1.499, p 0.01). This finding was confirmed by the larger area of granulations and fibrosis in cases of mesh suture than that of the checkerwise-reinforcing suture, suture with a mesh thread, and suture with a strip of mesh endoprosthesis. Another peculiarity of the connective tissue newly formed in the area of the mesh endoprosthesis in the form of the mesh thread was that collagen fibrils were arranged concentrically. By contrast, the mesh strip had collagen fibrils arranged in a longitudinal orientation parallel to the endoprosthesis. On day 60 of the experiment, all the series showed signs of maturation of the connective tissue in the form of the predomination of fibrils in cellular elements and their compaction. The area of fibrosis and granulations still prevailed in cases of the mesh suture, where neocollagenogenesis in the cells of the endoprosthesis was more pronounced than that after the application of a reinforcing suture, a mesh thread, and a strip of mesh endoprosthesis. CONCLUSION: The absence of wound complications and negative impact on the surrounding tissues indicated the safety of using the mesh suture. The strengthened characteristics associated with the peculiarities of the wound process showed that the mesh suture was effective in preventing the occurrence of postoperative hernia. Therefore, this method could be used in clinical practice.

Surgical Outcomes of Temporary Ileostomy Patients attended at a Tertiary Care hospital in Dhaka City

Background: Management of temporary ileostomy cases is very important considering the outcomes. Objective: The purpose of the present study was to observe the surgical complications of temporary ileostomy patients. Methodology: This prospective cohort study was conducted in the Department of Surgery at Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh over a period of six months from July, 2011 to December, 2011. All patients who had undergone temporary ileostomy after admission were selected as the study population. Patients with temporary ileostomy at any age in both male and female were included in this study. The surgical complications like prolapse, retraction, stenosis, necrosis, skin excoriation, parastomal hernia, bleeding and wound infection were recorded. Result: A total number of 100 patients were selected for observation and management of complications of temporary ileostomy. Their ages ranging from 15 to 65 years with mean age 33.9±11.92 years. Complications were developed in majority cases of cases (52.0%). Several systemic complications were recorded like electrolytes imbalance (31%), hypoproteinaemia (14%), RTI (6%) and significant weight loss (4%). Skin excoriation was the more frequent local complication developed in 32 (32%) patients. However, 36 patients developed laparotomy wound related complication. Conclusion: In conclusion high frequency of complications are found among the temporary ileostomy patients. Journal of Current and Advance Medical Research, January 2021;8(1):65-69

ASSESSMENT OF LAPAROSCOPIC MANAGEMENT OF INTESTINAL PERFORATION

Background: Intestinal perforation is a surgical emergency often, encountered. Usually, coelotomy is performed to manage intestinal perforation. It has been the gold standard approach to deal with intestinal perforation for the past decades in conjunction with various procedures. Post laparotomy wound related complications have been the biggest challenge for general surgeons till date, so much as to adding up to morbidity, as severe as burst abdomen. Laparoscopic management of perforation is a recent technique. Aim: The present study is aimed to assess the efficacy of laparoscopic management of intestinal perforation. Material and Method: Prospective study of 75 patient admitted and operated in National Institute of Medical Sciences & Research. Intestinal perforation (traumatic and not traumatic) will be managed through laparoscopic procedure. The perforated intestine will be – Identified and exteriorized with or without repair of perforation. Adequate peritoneal toilet would be performed. Sub diaphragmatic and pelvic spaces will be drained. The outcome of the patients will be assessed in regards to- Total hospital stay, Any associated complications – local or distant. Cause of mortality. Results: In present study the perforation peritonitis was found to be in 70.6% with 58.6% ileal perforation 17.1% jejunal perforation. In our study 52% patients managed laparoscopically 33.3% laparoscopic with exteriorization and 14.6% were converted to open surgery. Various cause for open surgery includes 27.2% multiple perforation,9.2% cardiac disease and 63.6v % site not identified laparoscopically. Patients managed laparoscopically had less complications as compared to open. Conclusion: dealing with intestinal perforation or associated peritonitis using minimal access technique is feasible and in turn helpful in minimizing the most dreaded morbidity i.e. the surgical site infections which can be reduced with improving skills and thorough lavage. Other factors associated with post-operative morbidity i.e. ambulation can be started as early as post operative day one. Prolonged hospital stay can be also be reduced and patients can be sent home early decreasing risk for nosocomial Keywords: Laparoscopic, intestinal, perforation, perforation peritonitis

A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

Effect of intra-abdominal hypertension on the strength of the postoperative scar of a laparotomic wound

Annotation. One of the main factors of postoperative eventration is intra-abdominal hypertension, which occurs in various surgical pathologies of the abdominal cavity. Despite the presence of a large number of scientific papers on the negative effect of intra-abdominal hypertension on the morphological state of granulation tissue in the area of the laparotomy wound, there are no publications on the impact on the strength of the postoperative scar. Therefore, the study aimed to investigate in an experiment on small laboratory animals the effect of intra-abdominal hypertension on the mechanical strength of the postoperative scar of a laparotomy wound. The experiment was performed on 120 laboratory rats, which underwent a median laparotomy and brought together the edges of the musculoaponeurotic layer of the anterior abdominal wall with simple nodal sutures. The main group consisted of 72 animals who developed intra-abdominal hypertension by inserting a container (condom) with a certain amount of Furacilin into the abdominal cavity. The comparison group consisted of 48 animals who had an empty condom inserted into the abdominal cavity after laparotomy. The mechanical strength of the postoperative scar of the laparotomy wound was determined by the method of G. V. Petrovich (2010) on the 1st, 3rd, and 5th day after the creation of intra-abdominal hypertension, by measuring the level of intra-abdominal pressure at the time of rupture of the postoperative scar of the laparotomy wound. Statistical analysis of the results was performed using Microsoft Excel spreadsheets and a package of statistical processing software PAST. Differences between study groups were determined using Mann-Whitney criteria. The results of the study indicate that the created intra-abdominal hypertension leads to a decrease in the mechanical strength of the postoperative scar of the laparotomy wound. The degree of the negative impact of intra-abdominal hypertension on the strength of the postoperative scar is inversely proportional to the level of intra-abdominal pressure.

The use of intestinal exteriorization technology in the treatment of congenital diaphragmatic hernia in a newborn infant

The result of the surgical treatment of a newborn infant with congenital diaphragmatic hernia complicated by pulmonary hypertension and ischemic lesion of the small intestine is presented. Using the technology of intestinal exteriorization after conversion of thoracoscopic access to laparotomy, plastic surgery of the left dome of the diaphragm, and moving the changed loops of the small intestine into a silo sewn to the edges of the laparotomy wound allowed avoiding serious complications in the postoperative period. 7 days after the first operation, bowel loops were immersed in the abdominal cavity, and suturing of the laparotomy wound was performed. During the follow-up examination for 2 years after the operation, the diaphragm is usually located, there are no signs of impaired bowel function.

Differentiated treatment tactics in surgery of liver echinococcosis

Purpose of the study. Improving the quality of treatment for liver echinococcosis by improving surgical tactics and developing eff ective methods to reduce disease recurrence. Materials and methods: 371 patients with echinococcosis of the liver, who were admitted to the surgery department of the 2nd clinic of Samarkand State Medical Institute, were examined. Of the 371 patients in 311 (83.8%) patients, the disease was detected for the fi rst time and in 60 (16.2%) patients, echinococcosis was recurrent. The results of the study: compared with 2005–2008. the incidence of postoperative complications decreased from 13.1 to 4.3%. Complications such as suppuration of the residual cavity (6 times), suppuration of the laparotomy wound (2 times), the formation of bile fi stulas (3 times), and no subphrenic abscesses began to occur much less frequently. The duration of inpatient treatment after surgery decreased by 2 times compared with the control — from 21.2 ± 1.2 to 10.9 ± 0.3 days. Conclusions: the developed algorithm for choosing the tactics of surgical treatment of liver echinococcosis, taking into account the integrated approach to choosing access, the method of treatment and elimination of the residual cavity, as well as preventive chemotherapy, has improved the quality of care by reducing the frequency of immediate postoperative complications from 12.5% to 4, 3% (p = 0.027 according to the χ2 criterion) and relapse of the disease from 11.9% to 2.6% (p = 0.031 according to the χ2 criterion).