Continuous Mass Closure Research Articles

High rate of incisional hernia observed after mass closure of burst abdomen.

This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3cm and small steps of 5mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17months (min 4, max 67months). Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients.

Wound dehiscence with continuous versus interrupted mass closure of transverse incisions in children with absorbable suture: a randomized controlled trial

IntroductionNumerous meta-analyses done on adults suggest superiority of continuous mass closure technique, but any such study does not exist for the pediatric age group. The results in adults cannot be...

Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery.

BackgroundSurgical site infection (SSI) is a common morbidity in patients undergoing colorectal surgery, and the focus of previous studies has primarily been on incisional SSI. Most reports thus far have focused on open surgery rather than on laparoscopic colorectal surgery (Lap CR). Therefore, the aim of the present study was to identify the risk factors for incisional SSI in patients undergoing elective Lap CR.MethodsThis retrospective study was conducted to evaluate the occurrence and risk factors of incisional SSI for elective Lap CR. From January 2008 to June 2018, 1825 consecutive patients with a preoperative diagnosis of colorectal cancer who underwent Lap CR were analyzed at a single institution.ResultsIncidence of incisional SSI was 3.3%. Postoperative hospital stay (days) was significantly longer in the incisional SSI group than in the non‐incisional SSI group (8 [6‐12] vs 10 [8‐19], P < 0.001). Incisional SSI were significantly associated with five operative factors: blood loss (g) (P < 0.014), midline wound length (mm) (P = 0.038), suture materials (P = 0.014), suture technique (interrupted vs continuous mass closure, P = 0.003), and organ/space SSI (P = 0.041). Multivariate analysis showed that continuous mass closure (odds ratio 0.290; 95% confidence interval 0.101‐0.831, P = 0.021) was the only factor independently associated with the incidence of incisional SSI.ConclusionsIncidence of incisional SSI was comparable to that in previous reports. Continuous mass closure decreased the risk of incisional SSI in elective Lap CR.

WOUND DEHISCENCE;

Objectives: To compare the continuous and interrupted closure in term offrequency of wound dehiscence in emergency midline laparotomy incision. Study Design:Randomized controlled trial. Setting: Surgical Unit-I, Allied Hospital Faisalabad. Period: From15th March 2014 to 15th November 2014. Material and Methods: Two hundred patients werediagnosed clinically by taking thorough history and examinations were included. Fascial layerof wound of the patients sampled for group A was closed with interrupted mass closure withprolene no.1 whereas in group B was closed by continuous mass closure with prolene no1. All included patients were kept nothing by mouth. Resuscitation was done with, ringerslactate and blood transfusion if needed until adequate urine output (0.5 ml/kg/hr). Base lineinvestigations were done. After resuscitation and giving preoperative antibiotics, patients wereexplored through mid-line incision. Obvious source of contamination was dealt with accordingly.Variables wound were examined daily for any sign of dehiscence. Temperature pulse wasmeasured daily along with surgical site examination for any kind of discharge, stitches cutthrough and gut visibility through wound. In case of no complication patient was discharged ontenth postoperative day, which was the end point of study. Results: There were 61 (61%) malesand 39 (39%) females in group A, while in group B, 63 (63%) males and 37 (37%) females withmean ages of patients were 39.77+10.16 and 38.61+9.75 respectively. The wound dehiscencewere found 7 (7%) in Group-A and 18(18%) in Group-B while remaining 93 (93%) in Group-Aand 82 (82%) in Group-B had no morbidity statistically (p&lt;0.01). Conclusion: It is concludedthat wound dehiscence is significantly higher in continuous closure as compare to interruptedclosure for emergency midline laparotomy incision for generalized peritonitis.

Abdominal closure with interrupted ‘X’ sutures prevent burst abdomen better when compared with continuous mass closure: A randomised trial in patients with perforative peritonitis

Introduction Burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. It has a significant impact on health care cost, both for the patient and the hospital.

Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania.

BackgroundThe optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. This study was undertaken to describe our own experiences with abdominal fascial closure following elective midline laparotomy and compare with what is described in literature.MethodsThis was a descriptive prospective study of patients who underwent elective midline laparotomy at Bugando Medical Centre between March 2009 and February 2014.ResultsA total of 872 patients (M:F = 2.8:1) were studied. The median age was 38 years. The fascia closure was performed with a continuous and interrupted sutures in 804 (92.2%) and 68 (7.8%) patients, respectively. Mass closure and layered closure were performed in 842 (96.6%) and 30 (3.4%) patients, respectively. Monofilament sutures were applied for fascia closure in 366 (42.0%) patients, multifilament sutures in 506 (58.0%) patients. Non-absorbable sutures were chosen in 304 (34.9%) patients, slowly absorbable sutures in 506 (58.0%), and moderately absorbable sutures in 62 (7.1%) patients. Sutures used for fascial closure were vicryl 464 (53.2%), nylon 250 (28.7%), prolene 62 (7.1%), PDSII 54 (6.2%) and silk 42 (4.8%). Sutures with the strength of 0 were used in 214 (24.4%) patients, with strength of 1 in 524 (60.1%) patients, and with strength of 2 in 134 (15.4%) patients. The mean time required for massive closure of the midline incision was 8.20 ± 6.12 min whereas in layered closure, the mean time required for closure was 12.22 ± 7.11 min and this was statistically significant (p = 0.002). Mass closure was significantly associated with low incidence of wound dehiscence and incisional hernia (p < 0.001). Continuous suture was significantly associated with low incidence of wound dehiscence and incisional hernia as compared to interrupted suture (p < 0.001). Non-absorbable sutures were significantly associated with increased incidence of persistent wound pain and stitch sinus as compared to absorbable sutures (p < 0.001). The use of monofilament sutures was insignificantly associated with low incidence of surgical site infection as compared to multifilament sutures (p = 0.051). Prolene was significantly associated with persistent wound pain as compared to vicryl (p = 0.017).ConclusionContinuous mass closure with vicryl is commonly used for abdominal fascial closure following elective midline laparotomy in our setting and gives satisfactory results.

Continuous mass closure of the abdominal wall for the unassisted surgeon: ‘the pinkie technique’

Continuous mass closure of the abdominal wall for the unassisted surgeon: ‘the pinkie technique’

Effect Of Retention Sutures For Prevention Of Abdominal Wound Dehiscence After Laparotomy In High Risk Patients(A Prospective Study).

BACKGROUND: Wounds and their management are fundamental to the practice of surgery.Surgical wound dehiscence after laparotomy remains a serious complication.To evaluate the effect of prophylactic retention sutures in patients with a high risk for wound dehiscence who underwent midline laparotomy. Patients and methods:One hundred fifty(150) cases were randomized to form two groups with 75 patients each: a prophylactic group by using retention sutures and an non prophylactic group. A central randomization for both hospitals was performed. Two patients in the non prophylactic group and three patients in the prophylactic group In the non prophylactic(control) groupStandard midline incision and continuous mass closure technique was used in each case using a running looped 1/0 nylon string located 1 cm from the edge of the lineaalba.In the prophylactic group, the fascia was sutured using the same technique as the non prophylactic group; however, retention sutures were added using a 1/0 nylon string every 10 cm and contained 5 cm of the skin, subcutaneous tissue, rectus muscle, and abdominal fascia (except peritoneum) on each side. All fascia closures were performed by tow attending surgeons who adhered strictly to the protocol.Occurrence of abdominal dehiscence was assesseddaily by precise examination of the wound. Results:The incidence of abdominal wound dehiscence was 3 patients (4%) in the prophylactic group and 10 patients (13.3%) in the control (nonprophylactic )group (P = 0.007 ) therefore it is significantConclusion:Ourconclsion that prophylactic retention sutures can decrease the incidence of abdominal wound dehiscence but although there is decrease incidence of post operative evisceration ,wound infection and post operative pain , there was no significant difference.

Knotting in continuous mass closure of the abdomen.

Journal Article Knotting in continuous mass closure of the abdomen Get access S Paterson-Brown, S Paterson-Brown Academic Surgical Unit, St. Mary's Hospital, London W2 1NY, UK Search for other works by this author on: Oxford Academic Google Scholar H A F Dudley H A F Dudley Academic Surgical Unit, St. Mary's Hospital, London W2 1NY, UK Correspondence to: Professor H. A. F. Dudley Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 73, Issue 8, August 1986, Pages 679–680, https://doi.org/10.1002/bjs.1800730833 Published: 08 December 2005

Addition of Rectus Sheath Relaxation Incisions to Emergency Midline Laparotomy for Peritonitis to prevent Fascial Dehiscence

The incidence of fascial dehiscence and incisional hernia after two methods for abdominal wound closure (rectus sheath relaxation incisions and conventional mass closure) was studied in a randomized prospective clinical trial in a consecutive series of 100 patients undergoing midline laparotomy for peritonitis. The two groups were well matched for etiologies of peritonitis, the surgical procedures performed, and the presence of known risk factors for fascial dehiscence. Fifty patients each were randomized either to the conventional continuous mass closure procedure or the rectus sheath relaxation incision technique (designed to increase wound elasticity and decrease tension in the suture line) using identical polypropylene sutures. The incidence of postoperative complications such as duration of ileus, chest infection, and wound infection were not statistically different between the two groups. The intensity of postoperative pain in the rectus sheath relaxation incision group was significantly less. The incidence of wound hematoma was significantly increased in the rectus sheath relaxation incision group. The incidences of fascial dehiscence (16% vs,28%; p < 0.05) and incisional hernia (18% vs, 30%; p < 0.05) were significantly lower after rectus sheath relaxation incisions compared to conventional mass closure. Closure of the midline laparotomy wound in cases of peritonitis using the rectus sheath relaxation technique is safe and less painful, provides increased wound elasticity and decreased tension on the suture line, and significantly decreases the incidence of wound dehiscence.

Wound strength in abdominal incisions: A comparison of two continuous mass closure techniques in rats

OBJECTIVES: The primary objective of this study was to determine whether continuous simple mass closure or continuous far-near, near-far (Smead-Jones) mass closure of longitudinal midline abdominal incisions results in a stronger wound. A second objective was to compare the time required to perform each type of closure. STUDY DESIGN: A midline laparotomy was performed on 102 male Sprague-Dawley rats. the skin was incised from xiphoid to pubis and reflected away from the midline. The rectus sheath was imprinted with a stamp to demarcate a standardized 5 cm midline incision. The stamp also provided loci for suture bites 5 mm from the incision edge and 10 mm apart. A longitudinal midline incision was made. Closure technique was determined by random assignment. The time required to close each incision was recorded. On postoperative day 7 wound strength was measured by inserting a condom into the abdomen and filling it with water until the abdomen burst. Pressure was measured in millimeters of mercury. Student t test, χ 2 test, and Fisher's exact test were used for statistical analysis. RESULTS: Animals closed with the continuous simple mass closure ( n = 50) had a mean weight of 344.43 ± 33.2 gm (mean ± SD) and those closed with the continuous far-near, near-far mass closure technique ( n = 52) weighed 344.86 ± 36 gm. Abdominal bursting pressure was 480.8 ± 62.6 mm Hg in the continuous simple group, whereas it was 554.4 ± 63.6 mm Hg in the continuous far-near, near-far group ( p < 0.000001). The time required to close the wound with the continuous simple technique was 365.4 ± 66.2 seconds. The continuous far-near, near-far closure group required 570.6 ± 70.8 seconds ( p < 000001). CONCLUSION: Our study reveals that the continuous far-near, near-far mass closure technique results in significantly greater wound strength than the continuous simple mass closure on the basis of the intraperitoneal pressure required to burst the abdomen. We believe that the far-near, near-far closure provides superior strength by creating two loops of suture over which forces that may disrupt the wound can be distributed. Furthermore, use of a continuous suture for this technique distributes tension along the entire length of the incision. Disruptive forces are thus divided evenly among all suture sites. A second purported advantage of continuous closur is the speed with which it can be performed. However, the greater wound strength of the continuous far-near, near-far technique comes at the expense of requiring 56% more time to complete than the continuous simple mass closure. Our data suggest that greater wound security is worth the increased time required for this repair.

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.