Closure Of Abdominal Incisions Research Articles

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UpToDate| June 2023 UpToDate® ASA Monitor June 2023, Vol. 87, 31. https://doi.org/10.1097/01.ASM.0000938852.60627.fa Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation UpToDate®. ASA Monitor 2023; 87:31 doi: https://doi.org/10.1097/01.ASM.0000938852.60627.fa Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: perioperative care, surgery specialty, surgical procedures, operative, gloves, protective UpToDate® and ASA Monitor are collaborating to present select content abstracts on “What's New.” UpToDate is an evidence-based, clinical support resource used worldwide by health care practitioners to make decisions at the point of care. For complete, current “What's New” content, or to become a subscriber for full content access, go to www.uptodate.com. “What's New” abstract information is free for all medical professionals. Routine glove and instrument change prior to closure of abdominal incisions (December 2022) Whether changing gloves and using new instruments prior to wound closure affects surgical site infection (SSI) rates is uncertain. In an unblinded cluster randomized trial of over 13,000 patients undergoing intra-abdominal surgery in low- to middle-income (LMIC) countries, the risk of SSI was lower when routine glove and sterile instrument change was performed prior to closure compared with no glove or instrument change (16 versus 19%).1 The results from this... You do not currently have access to this content.

P-016 INCISIONAL HERNIA AFTER ABDOMINAL EMERGENCY SURGERY. IMPACT OF PREVENTIVE SELF-ADHESIVE POLYESTER MESH PLACEMENT

Abstract Objective Analyze the results of the self-adhesive polyester mesh placement in the prevention of the postoperative evisceration and incisional hernia after median abdominal incision during an emergency digestive surgery. Material and methods A prospective observational study was done in those patients who underwent a midline abdominal incision and a self-adhesive polyester mesh was placed in onlay position, for an emergency digestive surgery between December 2020 and December 2022. Analysis was done by means of demographics, body mass index (BMI), blood tests, ASA, P-Possum score, etiology, surgical contamination, abdominal incision closure, postoperative records (≥ 90 days) categorized with Clavien-Dindo (CD) classification and 1 year of follow-up. Results Sixty patients were included, mean age 62.86, (57.6% men), 52% were ASA III, BMI>30 12%. Most frequent etiologies were complicated small bowel obstruction (17) and complicated acute sigmoid diverticulitis (12). Postoperative records showed a 26,6% of morbidity, 93.7% were D I- II (minor) and 6.3% CD IIIb. Neither wound evisceration nor incisional hernia was observed during the follow-up. A significative relationship (p<0.05) was observed between BMI, preoperative C-reactive protein and ASA classification with postoperative complications, same relationship was observed between surgical contamination but without statistical significance. Conclusions In this series, a preventive self-adhesive polyester mesh placement after abdominal midline incision during emergency digestive surgery, showed an acceptable rate of postoperative complications with a low rate of local morbidity and a good results during the follow-up

Review of incisional hernias

The 10 to 15% of patients get incisional hernias following any type of abdominal wall incision, with midline wounds carrying a larger risk (3 to 20%). Infection at the surgery site, obesity, smoking, malnutrition, and poor surgical technique are risk factors. Clinical signs include an abdominal bulge at or near a prior incision, which, in non-obese individuals, is frequently identified by palpating the split borders of the fascial defect. CT imaging is particularly useful for complicated ventral hernias, which are characterized by enormous size or considerable loss of dominance. For the purpose of detecting any contents within the hernia sac and deciding whether preoperative abdominal expansion is necessary to lower the risk of postoperative abdominal compartment syndrome, preoperative CT imaging is crucial. When clinically necessary, surgeons should think about making an incision outside the midline and employ the proper fascia closure procedures to lower the likelihood of an incisional hernia. Although the implantation of preventative mesh during the closure of abdominal incisions is being studied, routine usage is not advised owing to probable long-term problems. Incisional hernias can be treated surgically or expectantly, and the patient should be informed of both options.

INCIDENCE OF SURGICAL SITE INFECTION/ WOUND GAPING IN SUTURED VS STAPLED CLOSURE OF ABDOMINAL INCISION: A COMPARATIVE STUDY

Background Surgical wound is any wound inicted during surgical process and infection of surgical wound is a relevant complication with an incidence of 1% to 3%. Many factors are responsible for the occurrence of surgical site infections, like age, presence of comorbidities, type of procedure, wound closure method, level of contamination etc. Surgical Site Infection or SSI is associated with a signicant economic burden in terms of extended length of stay and increased costs of treatment. Objectives- To determine whether the incidence of surgical site infections differed after wound closure with non-absorbable suture material vs skin stapler, in elective abdominal surgeries. Methods- A comparative study to determine the incidence of surgical site infections after elective abdominal surgery was conducted in a tertiary care setup for a duration of one year. The study population was divided by random computer method in two arms, consisting of 30 patients each. In one arm the abdominal wound after elective surgery was closed with non-absorbable sutures while in the other with skin staplers. Outcomes were noted in terms of Surgical site infection, i.e, presence of wound gape, burst abdomen, closure duration, duration of hospital stay and interventions like secondary suturing, daily cleaning and dressing (CnD) Results- A total of 60 patients who underwent elective abdominal surgeries were divided into two arms of 30 patients each. Wound closure in one group done by non-absorbable suture material while in the other group with skin stapler. The groups were comparable in demographics, ASA (American society of Anaesthesiologist) grading and CDC (Centre for disease control) class of surgical wound. In our study, Surgical site infections were detected in 33.3 % (10 patients) in the sutured arm of closure of abdominal incision, while SSI were detected in 26.6 % (8 patients) of stapled arm of closure of abdominal incision. No signicant difference encountered in the incidence of SSI in sutured and stapled closure of abdominal wound. 76.7% (23 patients) underwent wound closure within 10 minutes in the stapled arm, while only 20 % (6 patients) in the sutured arm had surgical time duration of wound closure less than 10 minutes (p value < 0.001), the wound closure duration in the stapled arm was signicantly less compared to the sutured arm. Conclusions- There was no signicant difference in the incidence of surgical site infections in both the groups, but the surgical time duration of wound closure was signicantly lower in the stapled group.

Outcome on Surgical Site Infections for the Closure of Abdominal Incisions in General Surgery

Objective: To determine the frequency of surgical site infections according to the closure of abdominal incisions (skin staplers versus suture stitches) in General Surgery at Liaquat University of Medical and Health Sciences (LUMHS). Material and Method: This cross-section comparative study was conducted at the Department of General Surgery at LUMHS. The study was conducted for one year from January 2021 to December 2021. All the patients aged more than 12 years, both genders and who had undergone abdominal surgeries were included. Patients were divided into two groups group A and group B as per closure of the abdominal incisions. Patients in group A underwent staplers wound closure and patients in group B underwent wound closure by suture stitches. Patients were assessed for postoperative surgical site infection during hospital stay. All the data were collected via self-made study proforma. SPSS version 26 was used for the purpose of data analysis. Stratification with respect to the effect modifiers was done and a p-value < 0.05 was taken as significant. Results: In this study, a total of 41 cases were comparatively studied regarding surgical site infections as to the type of wound closure. The average age of the stapler’s patients’ group was 36.70+6.22 years and the average age of the suture patients’ group was 42.47+5.09 years. Males were most common in both groups without a significant difference (p-929), while average duration of closure was significantly lower in stapler group as compared to suture group (p-0.001). Of all, 12 cases had wound infection, particularly as 4 cases had infection grade I, 5 cases had grade II infection and 2 cases had grade III infection. Although frequency of surgical site infection was statistically insignificant (p-0.223). Conclusion: The wound closure skin stapler’s method was observed to be effective in terms of short duration, while the frequency of surgical site infection was higher in stapler closure but statistically insignificant as per both techniques. Keywords: Wound infection, stapler, suture, effectiveness

Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children: Primary Closure or Delayed Primary Closure?

Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.

Technique of Midline Abdominal Incision Closure Among 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

A New Method for Surgical Abdominal Mass Closure After Abdominal Fascial Dehiscence Using Nasogastric Tube and Hemovac Perforator: A Case-Series Study

As the challenge for finding the best abdominal incision closure technique continues, surgeons are aiming to minimize postoperative wound complications such as wound dehiscence and hernia as an acute or late manifestation. In order to achieve this goal, several abdominal opening and closure techniques have been tried. In this article, we describe a method in which we used a nasogastric tube (NGT) in mass closure for patients with fascial dehiscence. In this case-series study, a total number of 25 patients participated. All of the patients had abdominal dehiscence after a surgery and had to undergo for another. An NGT was used for abdominal closure. The patients were followed for a month and were examined for any signs and symptoms of fever, infection, pain, material expenses, closing time, and laboratory data. The data were analyzed using SPSS software V.22. Mean ± SD and frequencies were used for describing the variables. The mean NGT mass closure material expenses for each patient were 8400.00 ± 0.00 IRR (around 0.25 US dollars). The mean closure time after the operation was 13.08 ± 3.09min. There was no evidence of infection among the patients as well as no other complications after the surgery in the 1-month study period. Abdominal mass closure with NG tube suturing technique is associated with reduced time required for closure of the incision, incidence of wound dehiscence, and the incidence of incisional hernia as well as infection, with a considerable low cost.

Negative pressure therapy is effective in abdominal incision closure

BackgroundCDC wound classification demonstrates surgical site infection (SSI) occurs in 15%-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been used to decrease SSI rates in midline laparotomy incisions; however, no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications, but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions. MethodsRetrospective review of adult patients who underwent laparotomy between January 2013 and June 2014 with midline closure using INPWT. Only class III or IV wounds were included. Laparotomy incisions were loosely closed. INPWT set at 125 mm Hg is placed over oil emulsion impregnated gauze. INPWT is removed after 5 d and the wound left open to air. Records were reviewed for immediate and/or delayed surgical site complications. Primary end point was 30-d incisional SSI. Secondary end points included other surgical site complications. ResultsOne class III and 12 class IV wounds were treated with INPWT for a median of 5 d. The class III wound developed a small skin dehiscence with no evidence of superficial or deep SSI. Among class IV wounds, the rate of superficial and deep incisional SSI was 25% and 0%, respectively. The overall surgical site complication rate was 41.7%. ConclusionsINPWT in closure of high-risk midline laparotomy incisions is a safe, effective method of wound closure with equivalent SSI rates to previously described methods.

The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.

Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients. Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results. The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent. The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.

Abdominal incision closure: small but important bites

Abdominal incision closure: small but important bites

Multi-Center Randomized Controlled Trial on the Effect of Triclosan-Coated Sutures on Surgical Site Infection after Colorectal Surgery.

Surgical site infection (SSI) remains the most frequent complication after colorectal resection. The role of sutures coated with antimicrobial agents such as triclosan in reducing SSI is controversial. This was a multi-center randomized controlled trial with patients and outcome assessors blinded to treatment. The study was performed in four university referral hospitals. Patient candidates for elective colorectal resection were assigned randomly to abdominal incision closure with polyglactin 910 triclosan-coated sutures (triclosan group) or with polyglactin 910 without triclosan (control group). The primary outcome was the rate of SSI within 30 d after hospital discharge. The secondary outcomes were the overall rate of incision complications and length of hospital stay (LOS). Two hundred eighty-one patients (triclosan group: 140; control group: 141) were analyzed after randomization. The rate of SSI was 12.9% (18/140) in the triclosan group versus 10.6% (15/141) in the control group (odds ratio: 1.24; 95% confidence interval: 0.60-2.57; p=0.564). Secondary outcome analysis showed an overall incision complication rate of 38.3% in the control group versus 45.7% in the triclosan group (odds ratio: 1.36; 95% confidence interval: 0.84-2.18; p=0.208). Median LOS was 11 d in both groups (p=0.55). Surgical sutures coated with triclosan do not appear to be effective in reducing the rate of SSI.

Triclosan-coated abdominal closure sutures reduce the incidence of surgical site infections after pancreaticoduodenectomy.

Surgical site infection (SSI) is a serious complication after pancreaticoduodenectomy (PD). To prevent microbial colonization of suture material in operative wounds, triclosan-coated polyglactin sutures with antibacterial activity have been developed recently. Several clinical studies have shown that the use of such suture reduces SSIs in various operations, but its efficacy in PD has not been studied. We evaluated whether the incidence of SSI can be reduced when triclosan-coated sutures are used for abdominal incision closure after PD. This controlled clinical trial took place between December 2005 and February 2012 with a total of 198 consecutive patients who had undergone PD. The study group received triclosan-coated polyglactin 910 antimicrobial sutures between March 2009 and February 2012, and the control group received conventional wound closure between January 2005 and February 2009. We compared the rate and types of infections in the two groups. In the study group, age, the incidence of diabetes mellitus, smoking history, and operating time were significantly greater than in the control group. The rates of SSI were 4.5% in the study group and 14.5% in the control group (p=0.037). The use of triclosan-coated sutures may help reduce the incidence of SSI after PD compared with conventional non-antibiotic sutures.

Effect of Hypericum perforatum on intraperitoneal adhesion formation in rats.

IntroductionThe aim of this study was to evaluate the efficacy of Hypericum perforatum for prevention of adhesion formation in rats.Material and methodsTwenty-four female wistar rats underwent left uterine horn adhesion model. Rats were randomised into 4 groups. Group 1 (Control): Closure of abdominal incision without any agent administration. Group 2: Closure of incision after administration of intraperitoneal (i.p.) Ringer's lactate solution. Group 3: Closure of incision after administration of i.p. olive oil (diluent of H. perforatum). Group 4: Hypericum perforatum extract (Ecodab®) was administered i.p. before the closure of incision. Fourteen days later, relaparatomy was performed and surgical adhesion scores, inflammation and fibrosis scores were noted. Groups were compared according to these scores.ResultsThere was statistical significant difference between ringer's lactate group and olive oil group according to surgical adhesion score (p = 0.009). However, groups were not different according to inflammation and fibrosis scores (p > 0.05).ConclusionsDespite antiinflammatory, antioxidants and antimicrobial properties of H. perforatum, our results revealed no positive effect of H. perforatum on the prevention of intraperitoneal adhesion formation.

Efficacy of Delayed Primary Closure of Abdominal Incisions after Large Bowel Perforation

Efficacy of Delayed Primary Closure of Abdominal Incisions after Large Bowel Perforation

Staged reconstruction after gunshot wounds to the abdomen.

Immediate closure of abdominal incisions after exploration and treatment of gunshot wounds is not always feasible or advisable. Significant bowel edema after massive fluid resuscitation might preclude primary closure, whereas any attempt to close under tension might result in complications ranging from wound dehiscence, infection, and necrosis to the abdominal compartment syndrome with abdominal, cardiopulmonary, and renal complications. For these difficult cases, the open technique has been recommended. The abdomen is left open and is closed when the patient's condition permits. When immediate wound approximation is not possible, temporary coverage can be achieved with a mesh, patch, or a split-thickness skin graft and the definitive reconstruction is deferred for a more optimal time. The purpose of this retrospective study is to report the authors' experience with staged abdominal wall reconstruction after gunshot wounds. From 1989 to 1998, 1933 patients underwent exploratory laparotomy for penetrating wounds to the abdomen. Twenty-nine patients in grave condition and with multiple medical problems were comanaged by the Trauma and Plastic Surgery Services at Cook County Hospital with the following protocol: The abdomen was initially left open and exposed viscera were covered with a variety of methods, including a Gore-Tex patch (W. L. Gore and Associates, Inc., Flagstaff, Ariz.). A split-thickness graft was subsequently placed on the granulation tissue over viscera at an average of 14 days after the last laparotomy. These planned ventral hernias were definitively treated at an average of 7 months after the skin grafting procedure, primarily using the components separation technique. In 24 patients, the fascia was closed primarily without tension, while five patients required the use of synthetic mesh to restore fascial continuity. Nine patients underwent closure of a colostomy or repair of fistulas simultaneously with abdominal wall reconstruction. One patient developed a postoperative hernia, two developed superficial wound dehiscence that healed without further surgery, and one required re-exploration for a failed anastomosis after colostomy closure. All but one patient maintained a stable abdominal wall after the reconstruction. The authors concluded that staged abdominal wall reconstruction should be primarily recommended for patients with complex abdominal wounds and a compromised general condition that precludes primary closure. With this treatment protocol, patients can recover faster from their trauma surgery and the risk of perioperative complications can be reduced. After final reconstruction, the continuity, stability, and strength of the abdominal wall are maintained in the vast majority of cases with the use of autogenous tissue and without the need for alloplastic material. With close cooperation between the trauma team and the plastic surgeon and appropriate timing and planning of each stage, the success rate of the technique is high and the incidence of complications limited.

Tissue Adhesive (Octylcyanoacrylate) vs. Subcuticular Sutures for Closure of Gynecologic Surgical Incisions

Objective: The ideal method of wound closure should be simple, fast, sturdy, bacteriocidal, and inexpensive, with optimal cosmetic results. Synthetic tissue adhesives offer many of these qualities, and one such product (octylcyanoacrylate) has recently become available in the United States. This tissue adhesive has been shown to be effective for the closure of facial lacerations, but the safety and efficacy of this product for the closure of abdominal incisions has not been determined. The purpose of this study is to compare patient satisfaction, cosmesis, and complication rates of octylcyanoacrylate with a traditional skin closure technique for patients undergoing gynecologic surgery.

Subcutaneous suture placement versus delayed primary closure of abdominal incisions in patients 50% over ideal body weight

Subcutaneous suture placement versus delayed primary closure of abdominal incisions in patients 50% over ideal body weight

A randomized trial of abdominal incision suture technique and wound strength in rats.

To determine whether interrupted en bloc suture or continuous running mass suture technique for closure of abdominal incisions results in stronger wounds, and to determine the time required for each technique. Randomized trial. Arthur C. Guyton Animal Facilities, University of Mississippi Medical Center, Jackson. Male Sprague-Dawley rats. A midline laparotomy was performed on 103 rats that were separated into two groups using computer-generated random numbers. In group 1, incisions were repaired using a continuous mass closure suture technique. In group 2, incisions were repaired using an en bloc interrupted suture technique. Wound bursting pressure was determined on postoperative day 7. The time required to repair each incision was recorded. Continuous mass closure suture technique resulted in significantly greater wound strength (P < .05) and required significantly less time (P < .000001). Continuous mass closure suture technique is superior to interrupted en bloc closure with respect to wound strength and closure time.

Continuous absorbable suture pattern in the closure of ventral midline abdominal incisions in horses.

A retrospective study was performed to evaluate the healing of ventral midline abdominal incisions, closed with a simple continuous suture pattern using absorbable suture material, in 139 horses and foals. Dehiscence and incisional hernia developed separately in two horses. The low incidence of dehiscence and incisional hernia, compared with their reported incidence following the use of interrupted suture repair, leads the authors to recommend this alternative method of abdominal incision closure in horses. The security of closure is not sacrificed and the advantages of a rapid closure are desirable.