Comparison of outcome of interrupted versus continuous closure technique of rectus sheath in emergency laparotomies patients in terms of wound dehiscence.

Objective: To compare outcome of interrupted versus continuous closure of rectus sheath in emergency laparotomy patients, in terms of wound dehiscence. Study Design: Randomized Controlled Trail. Setting: Department of Casualty Surgical Pir Abdul Qadir Shah Institute of Medical Sciences, Gambat. Period: 1st January to 30th June 2020. Material & Methods: Total duration of study was 6 months. Total of 150 patients (75 in each group) were studied. Interrupted closure of rectus sheath was done in group “A” patients while continuous closure was done in group “B” patients, and efficacy in terms of wound dehiscence was compared in both groups. Results: Overall male to female ratio was1.29:1. The average age of the patients was 39.41 years +13.02SD. Wound dehiscence in Group “A” was found in 2.6% cases while 6.6% in Group “B” patients. Conclusion: Interrupted closure of Rectus sheath in emergency laparotomy is more effective than continuous closure in preventing wound dehiscence.

Prospective comparative study of modified Smead Jones versus conventional continuous method of fascial closure in emergency midline laparotomy

Background: A midline incision is simple, quick, bloodless and provides excellent exposure. So it is most commonly used access route for emergency laparotomy. But compare to other incision it increases incidence of postoperative wound dehiscence and an incisional hernia. Prevention of this complication is important in reducing post-operative morbidity and mortality. Present study was undertaken to compare the effectiveness of modified Smead Jones versus conventional continuous closure technique in terms of wound infection and wound dehiscence.Methods: A total of 100 patients from July 2017 to November 2019 were randomized in two groups of 50 each. Group A in which linea alba closure was done by modified Smead Jones technique and group B in which linea alba closure was done by conventional continuous closure technique.Results: 12 patients in group A and 28 patients in group B developed wound infection and 1 patient in group A and 7 patients in group B developed wound dehiscence.Conclusions: Modified Smead Jones technique is better than conventional continuous closure technique in management of closure of emergency midline laparotomy.

Laparoscopic reduction and repair of a left paraduodenal hernia

Left paraduodenal hernias are the most common type of congenital internal hernia, but they are difficult to diagnose without appropriate imaging. A 79-year-old man with a history of recurrent abdominal pain had another similar episode of abdominal pain, which prompted him to seek evaluation. The pain resolved spontaneously on arrival to the hospital. Enhanced CT scan showed the characteristic findings of a left paraduodenal hernia and laparoscopic repair was undertaken. The small intestine was reduced successfully, and the hernia orifice was approximated with a continuous closure. He was discharged uneventfully 4 days after admission. The characteristic clinical and imaging findings of paraduodenal hernias are reviewed. Laparoscopic repair is reasonable in patients who have a paraduodenal hernia without intestinal ischemia.

Comparison of interrupted-X technique closure versus conventional continuous closure of rectus sheath: a randomized control study

Background: A major surgical complication after emergency midline laparotomy is abdominal fascial dehiscence. Dehiscence is associated with increased morbidity and mortality rates up to 30%, prolonged hospital stay, and a long-term risk of developing incisional hernia. The risk factors of Wound dehiscence can surgeon factors or patient factors. This study was aimed at comparing effectiveness of interrupted-X technique versus conventional continuous closure of rectus sheath in midline laparotomy in emergency setting.Methods: This study was conducted in a total of 100 patients underwent midline laparotomy for perforation peritonitis in emergency setting. Out of which 50 patients underwent rectus sheath closure by interrupted-X technique (group A) and 50 patients by conventional continuous closure (group B) using non-absorbable, monofilament, no.1 polypropylene suture. Necessary preoperative patient data, wound length, the time taken for rectus closure, length of the suture material used, post-operative complications like wound dehiscence, surgical site infection, period of hospital stay were recorded for analysis.Results: Preoperative patient data among both the groups were comparable. Group A was found to have less wound dehiscence (p=0.001 for partial and p=0.008 for complete) and less period of hospital stay (p=0.054), which were statistically significant. Surgical site infections were similar in both groups. Group B was found to have less time taken for closure (p=0.003) and less length of suture material used (p=0.003), which were statistically significant.Conclusions: Interrupted-X technique of rectus sheath closure reduces the rate of wound dehiscence and period of hospital stay, although it consumes more length of suture material and more time for suturing as compared to conventional continuous closure.

Fuzzy -Continuous Posets

The aim of this paper is to generalize fuzzy continuous posets. The concept of fuzzy subset system on fuzzy posets is introduced; some elementary definitions such as fuzzy -continuous posets and fuzzy -algebraic posets are given. Furthermore, we try to find some natural classes of fuzzy -continuous maps under which the images of such fuzzy algebraic structures can be preserved; we also think about fuzzy -continuous closure operators in alternative ways. An extension theorem is presented for extending a fuzzy monotone map defined on the -compact elements to a fuzzy -continuous map defined on the whole set.