Elective Laparotomy Research Articles

Efficacy of Wound Instillation With Bupivacaine Through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison With Conventional Intravenous Analgesics.

Introduction A laparotomy can cause severe postoperative pain, which, if treated adequately, can result in reduced incidence of lung atelectasis and ileuspromoting early mobilization and faster recovery and in turn reducing the duration of hospital stays. Hence, effective postoperative analgesia is important to reduce postoperative stress and improve early surgical outcomes. Therefore, the hypothesis is based on the fact that following a midline laparotomy, instillation of local anaesthetic agent 0.25% bupivacaine through a wound catheter placed in the subcutaneous plane may provide better analgesia compared to the conventional intravenous analgesics and improve the early surgical outcomes. Methodology A prospective, comparative, quasi-experimental study was conducted on 80 patients planned for emergency or elective midline laparotomy procedures over a period of 18 months, who were randomly distributed into two groups of 40 each. The bupivacaine group consisted of 40 patients who received 10ml of 0.25% bupivacaine instilled through a wound catheter placed in the subcutaneous plane following a midline laparotomy. This was repeated every six hours for the first 24 hours followed by every 12 hours for the next 24 hours. The conventional intravenous (IV) analgesics group involved 40 patients who received conventional IV analgesics routinely used. Pain scores were recorded every four hours for 60 hours using the visual analogue scale (VAS) and dynamic visual analogue scale (DVAS). The parameters assessed were mean VAS and DVAS scores, number of rescue analgesic demands, cumulative rescue analgesic requirement, and early surgical outcomes. Wound complications were also assessed. Results Both groups shared similar demographic characteristics in terms of age, gender, comorbidities, and duration of operation. In comparison to patients who got standard IV analgesics, those who received 0.25% bupivacaine had improved postoperative analgesia. Between the two groups, there were statistically significant results in the number of rescue analgesic demands in the first 24 hours, but in the next 24 hours, it was statistically insignificant. The study also showed that bupivacaine instillation led to a significant decrease in postoperative lung complications and the length of hospital stays; however as hypothesised, it did not improve early surgical outcomes. Conclusion This modality, the instillation of bupivacaine through a wound catheter, is an efficient and technically simple method to provide optimal postoperative analgesia. It substantially reduces the need for systemic analgesics and can potentially avoid their related side effects. Hence, the armamentariumof multimodal analgesia can therefore include this method of delivering postoperative analgesia.

APPENDICEAL INFLAMMATORY MYOFIBROBLASTIC TUMOUR: A RARE POSTOPERATIVE FINDING

Introduction- Inammatory myobroblastic tumour (IMT), which usually affects children and young adults, is a rare neoplastic lesion of unknown aetiology.[1–5]Once thought to be reactive, now these lesions are considered to be neoplastic.[2] Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.[1–5] According to the World Health Organization, IMT is a distinctive lesion composed of myobroblastic spindle cells accompanied by an inammatory inltrate of plasma cells, lymphocytes, and eosinophils.[1–6] Inammatory myobroblastic tumour is a relatively new histopathological term. In the literature, this entity was formerly known as inammatory pseudotumor, plasma cell granuloma, plasma cell pseudo-tumour, pseudo-sarcomatous myobroblastic proliferation, reactive pseudo-sarcomatous response, omental-mesenteric myxoid hamartoma, and inammatory brosarcoma. This unication of descriptive terms was achieved on the basis of considerable morphological and clinical overlap, combined with both clinical and genetic evidenc of its neoplastic nature.[2,3,5,7] IMT was rst described in 1937 as a primary lung tumour [1,2,3,5,7] but it was subsequently recognized that virtually any anatomical site can be involved.[1,4,6,7] Most of the extrapulmonary IMTs are localized in the mesentery of the small intestine, omentum, and retroperitoneum.[1,4] To this date, IMTs of the gastrointestinal tract are rare.[1,3,8] Most of these reported cases are adolescent or adult males.[2,3] A 13 years old male patient presented to surgery casualty wi Case Report- th complaints of pain in abdomen vomiting for 4 days on clinical examination patient have tachycardia and tenderness in right iliac fossa. Initial USG A+P was suggestive of perforated appendix with early lump formation. Patient was managed conservatively and discharged after 3 days. But after 2 weeks patient again presented with similar complaints and progressively increasing lump in right lower abdomen. Lump was 15x8cm in right iliac fossa extending to hypogastric and right lumbar region rm to hard in consistency with mild tenderness on deep palpation. Ultrasound of abdomen suggestive of organised haematoma. CECT abdomen and pelvis suggestive of inamed appendix with suspicious perforation and well-dened heterogenous collection of max volume 340cc could represent organised haematoma. Patient was posted for elective exploratory laparotomy with intra op ndings of 1) mass of size 15x10x8cm located in right lower quadrant 2) whole specimen weighed 350gms 3) appendix showed diffuse inammation and adherent to mass. Appendicectomy along with excision of mass was done and sent for histopathology. HPE Report-Benign spindle cell lesion highly suggestive of inammatory myobroblastic tumour. IMT is a rare lesion that can represent a Conclusion- n unexpected intra-operative nding at emergency surgery. Generally, IMTs have a good outcome but they have a tendency for local recurrence and small risk of distant metastasis. IMT can be observed in appendices even though it is rare. Complete surgical resection should be the method for curative treatment. Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.

Emergency laparotomy at St Olav's Hospital, Trondheim.

Emergency laparotomies are associated with higher mortality and longer hospital stays than elective laparotomies. The purpose of this study was to survey patient characteristics, hospital care pathways, and mortality for patients undergoing emergency laparotomy at St Olav's Hospital, Trondheim. This is a retrospective cohort study of all patients over 18 years of age who underwent emergency laparotomy at St Olav's Hospital, Trondheim, between 1January 2015 and 1April 2020. Patients were selected based on National Emergency Laparotomy Audit inclusion and exclusion criteria. Surgeries due to trauma or appendicitis were excluded, as were those for gynaecological or vascular aetiology. Patient and surgery characteristics, as well as date of death, were retrieved from electronic medical records. A total of 939 patients with a median (interquartile range) age of 68 years (54-76) were included. Intestinal obstruction was the primary indication for surgery in 488 (52.0%) patients, followed by perforation in 220 (23.4%) and ischaemia in 85 (9.1%). In all, 788 (83.9%) patients underwent emergency surgery within the timeframe scheduled. The median postoperative hospital stay was 10 days (6-18) and 30-day mortality was 8.2%. Although caution should be exercised when comparing findings between studies, our results suggest that the quality of treatment at St Olav's Hospital, Trondheim, is on a par with that at similar institutions. At the same time, the study provides an opportunity to identify areas for improvement in the provision of emergency surgery.

STUDY ON THE CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH SURGICAL DRAINS FOLLOWING ELECTIVE ABDOMINAL SURGERIES

Aims And Objectives- To determine the surgical prole and outcome of patients with surgical drains following MATERIALS AND METHODS- Study design: observational study Period of study: december 2020 to January 2022 sample size :79 .All patients undergoing elective abdominal surgeries w INCLUSION CRITERIA: EXCLUSION ith drain placement CRITERIA: 1.Age <18yrs 2.Patients with pre-existing infection at surgical site 2.Patients with pre-existing infection at surgical site Results & Conclusion-Obese patients undergoing elective laparotomy suffer from local wound complications such as seroma, hematoma, pain at wound site, wound dehiscence, and surgical site infections. These complications occur because of increased subcutaneous fat thickness, poorly controlled bleeding points in subcutaneous plane. These will lead to increased morbidity for the obese patients and prolonged hospital stay. In this study, we have observed that there is positive correlation between SSI and BMI, with the Rate of SSI was seen more in BMI >25 as compared to BMI <25, there is increased wound complication associated with increase in age because of varied factors mentioned above. We observed less wound complications in female patients compared to males due to the probable benecial effect of estrogen on wound healing. Also we observed that patients with higher BMI are more prone for wound complications thus further increasing their length of hospital stay

Early feeding following elective laparotomy with gut anastomosis in surgical patients

Background: Early oral feeding has been listed as one of many factors that contribute to enhancing recovery after laparotomy due to its effect on postoperative ileus. Objectives: The aim of the study was to compare early feeding against controls on the reduction of postoperative ileus among patients undergoing elective laparotomy. Methodology: Consenting patients who had elective laparotomy with gut anastomosis in the Surgical wards of NAUTH Nnewi were randomised into Early feeding group and Control/ traditional delayed feeding group. In the Early feeding group, patients’ NGTs were removed within first 24 hours and graded oral intake was commenced. In the Delayed feeding group, patients were used as controls and were managed in the traditional way-nil by mouth until passage of flatus or faeces. Assessed outcome measure was time from completion of surgery to passage of flatus and faeces. Results: During the study period, December 2014 to November 2016 (2 years), 72 consenting patients who had elective laparotomy in the Surgical wards were randomised into the two groups- Group1 (n=36); Group 2 (n=36). The groups were similar in terms of gender, age, surgical procedures, and co morbidity. The age range was 20-81 years. The time from completion of surgery to first passage of flatus was 3.85days for Group1 and 3.92days for Group 2. Time from completion of surgery to first passage of stool was 4.57days for Group 1 and 4.76days for Group2. The time to flatus and faeces was shorter in early feeding compared to Controls but did not reach statistical significance (p0.115, p0.116 respectively). There were no significant differences noted in the complication rates among the groups. Conclusion: There was no statistically significant difference in the time to passage of flatus and faeces between the Early oral feeding group and controls.

Gum-chewing after elective laparotomy with gut anastomosis in surgical patients

Background: Gum-chewing has been listed as one of many factors that contribute to enhancing recovery after laparotomy due to its effects on postoperative ileus. Objectives: The aim of the study was to compare gum-chewing against controls on the reduction of postoperative ileus among patients undergoing elective laparotomy. Methodology: Consenting patients who had elective laparotomy with gut anastomosis in the Surgical wards of Nnamdi Azikiwe University Teaching Hospital(NAUTH), Nnewi were randomised into Gum-chewing group and Control/ traditional delayed feeding group. In the first Group patients’ Naso gastric tubes(NGT) were left insitu as they chewed gum 3 times a day from 1DPO. Patients in the second group were used as controls and were managed in the traditional way-nil by mouth until passage of flatus or faeces. Assessed outcome measure was time from completion of surgery to passage of flatus and faeces. Results: During the study period, December 2014 to November 2016 (2 years), 70 consenting patients who had elective laparotomy in the Surgical wards were randomised into the two groups- Group 1 (n=34) and group 2 (n=36). The groups were similar in terms of gender, age, surgical procedures, and co morbidity. The age range was 20-81 years. The time from completion of surgery to first passage of flatus was 3.07days for Group 1 and 3.92days for Group 2. Time from completion of surgery to first passage of stool was 4.00days for Group1 and 4.76days for Group2. Time to flatus and faeces was significantly shorter in the Gum-chewing group compared to Controls (p0.05 for both). There were no significant differences noted in the complication rates among the groups. Conclusion: Gum-chewing reduced the length of postoperative ileus significantly

Gum-chewing after elective laparotomy with gut anastomosis in surgical patients

Gum-chewing after elective laparotomy with gut anastomosis in surgical patients

Early feeding following elective laparotomy with gut anastomosis in surgical patients

Early feeding following elective laparotomy with gut anastomosis in surgical patients

Uterine smooth muscle tumors with uncertain malignant potential: analysis following fertility-saving procedures

ObjectiveThe aim of this study was to analyze the clinical and reproductive outcomes of patients treated with myomectomy who were histologically diagnosed with uterine smooth muscle tumor of uncertain malignant...

"Cross-over" versus mass closure techniques for elective midline laparotomies

"Cross-over" versus mass closure techniques for elective midline laparotomies

A randomized controlled trial evaluating the effects of transversus abdominis plane block with compound lidocaine hydrochloride injection on postoperative pain and opioid consumption and gastrointestinal motility in patients undergoing gynecological laparotomy.

Incorporation of transversus abdominis plane (TAP) block into multimodal analgesia has been emphasized in Enhanced Recovery protocols (ERPs). However, benefit is limited in clinical practice. A potential explanation is the short duration of analgesia of standard local anesthetics. Herein, this randomized, double-blind, controlled trial evaluated whether TAPB with long-acting compound lidocaine hydrochloride injection reduces postoperative pain. 164 patients undergoing elective gynecological laparotomy under sevoflurane anesthesia randomly received ultrasound-guided TAP block with either saline, or ropivacaine, or compound lidocaine before anesthesia induction. The postoperative pain intensity (primary outcome) was evaluated by pain 11-point numerical rating scale. We also recorded sufentanil consumptions, time to first flatus, side-effects and hospital stay after surgery. We reported that pain scores at rest at postoperative 3h in group 0.375% ropivacaine was lower than that in group saline [mean 2.4 (SD 1.2) vs. 3.0 (1.0), p = 0.036]. Compared with saline, 0.4% and 0.6% compound lidocaine caused lower pain scores at rest at postoperative 12h [2.8 (0.9) vs. 2.1 (0.9) and 2.0 (0.9), p = 0.016 and p = 0.006]. Sufentanil usage for the first postoperative 48h was lower in group 0.6% compound lidocaine than group saline [24.2 (5.4) vs. 45.6 (7.5) µg, p < 0.001]. Time to first flatus and hospital stay after surgery was shortest and the incidence of postoperative nausea was lowest in patients receiving 0.6% compound lidocaine. TAP block with 0.6% compound lidocaine hydrochloride injection attenuates postoperative pain, reduces opioid consumption, accelerates gastrointestinal function recovery, and shortens length of hospital stay in patients after gynecological laparotomy. ClinicalTrials.gov, identifier: NCT04938882.

Dexmedetomidine versus Clonidine for Improved Quality of Emergence from General Anaesthesia: A Randomised Placebo-Controlled Study

Introduction: Extubation of the trachea upon emergence from General Anaesthesia (GA) is often accompanied by potentially dangerous events, like coughing, hypertension, tachycardia, and agitation. The centrally acting a -2 agonist, dexmedetomidine, has been evaluated to attenuate the emergence/extubation response. However, there is insufficient evidence regarding the effectiveness of clonidine for the same purpose. Aim: This study aimed to evaluate the quality of emergence from GA in patients receiving clonidine infusion versus dexmedetomidine infusion. Materials and Methods: In this randomised, double-blinded trial conducted over a period of 5 months, 105 patients aged 18-70 years, of either sex, with American Society of Anaesthesiologists (ASA) grade I-III, scheduled for elective laparotomies with an estimated duration of 1-4 hours, were randomly assigned to groups D, C, and P. Group D received inj. dexmedetomidine 1 μg/kg, group C received clonidine 3 μg/kg, and group P received placebo (normal saline) via intravenous (i.v.) route over 10 minutes using a syringe pump, 10 minutes prior to the anticipated end of surgery. Haemodynamic parameters, cough, agitation, shivering, time to extubation, sedation, Visual Analogue Score (VAS), and Postoperative Nausea and Vomiting (PONV) scores were recorded before, during, and after extubation. The incidence of complications (hypotension, bradycardia, or others) was also recorded. Categorical data were expressed as proportions, while numerical data were presented as mean±Standard Deviation (SD) or median±Interquartile Range (IQR). Appropriate data were compared using Statistical Package for Social Sciences (SPSS) version 16.0. Results: A total of 105 patients were included, with 53 males and 52 females. There was no difference in the demographic characteristics, such as age, gender, and Body Mass Index (BMI), amongst the three groups. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)) were significantly lower in patients of group D and group C compared to the placebo group at 5, 10, 10, and 15 minutes, respectively, after the beginning of drug infusion (p-value &lt;0.05). Patients in groups D and C had significantly lower median cough scores at 20-25 minutes compared to the placebo group (p-value at 20 and 25 minutes was 0.012 and &lt;0.001, respectively). There was a significant reduction in postoperative pain, as measured by VAS score, and an increase in sedation, as measured by Ramsay sedation score, in groups D and C compared to the placebo group. There was no statistical difference in agitation score, shivering score, PONV score, time to extubation, and incidence of complications among the three groups (p-value &gt;0.05). Conclusion: Administration of 1 μg/kg of dexmedetomidine or 3 μg/kg of clonidine over 10 minutes prior to recovery from General Endotracheal Tube Anaesthesia (GETA) results in a better quality of recovery, as evidenced by a statistically significant reduction in cough scores in patients undergoing elective laparotomies when compared to patients of placebo group.

UTERINE SKIN PENSTOCK – SINGULAR ENTITY

Fistula is an abnormal communication between two epithelial surfaces; uterocutaneous fistula is extremely rare. 26year female with seropurulent discharge from post Lower segment caesarean section (LSCS) scar for 45 day postpartum. In view of sinus, x-ray sinogram was done which revealed a fistulous tract of length 7 cm anteroposteriorly with the subcutaneous collection extending into the endometrial cavity with multiple arborization. Intra-operatively, communication with the endometrial cavity ascertained. An elective laparotomy with exploration and removal of fistulous tract was proceeded. On exploration, the wall of the uterus was found to be irreparable proceeded with subtotal hysterectomy with bilateral salpingectomy, peritoneal lavage and closure. Infection must be treated with appropriate antibiotics and drainage of any abscess. Surgical management is the mainstay in the treatment of fistula. Medical treatment using GnRH agonist for six months has been described in literature. Conservative treatment, including resection of the fistula tract and closure of the uterus, should be considered with the risk of recurrence.

Early Postoperative Small Bowel Obstruction: Can We Blame the Drain?

Abdominal drains are frequently used in both elective and emergency laparotomies, in order to prevent formation of postoperative collections in gravity-dependent positions or as means of early detection of postoperative hemorrhage and anastomotic leaks. Despite the benefits of their use, rare drain-related complications have been reported in the literature, including adhesional band formation and intestinal erosion. Herein, we present an extremely rare case of early, non-resolving postoperative small bowel obstruction after abdominoperineal resection for low rectal cancer, which was induced from firm extrinsic compression of the distal ileum by a corrugated pelvic drain.

Cyclic pulse loads generate the new concept in abdominal wall reconstruction: suture closure

Aim: Incisional hernias frequently occur after open abdominal surgery. Up to 30% of elective midline laparotomy closures result in an incisional hernia. The properties of a safe abdominal wall reconstruction must be assessed under lifelike conditions to obtain a realistic estimate of the durability. The interplay of the biomechanical qualities determines the long-term stability of a repair. Various suture materials and techniques for optimal closure of the abdominal wall are still under discussion. The results of this experimental study might significantly affect the active discussion about optimal suturing techniques for median abdominal wall closure. Methods: For this purpose, a bench test was developed that delivers repetitive cyclic pressure impacts to the abdominal wall, simulating coughs. This allows the assessment of the reconstructed abdominal wall as a compound. We used stiff porcine abdominal walls and elastic bovine flanks as model tissues. We chose two different types of defects. Type one consisted of a 15 cm long medial incision, whereas for type two, a 5 cm circular defect was added in the center of the incision. The incisions were solely sutured in large-bite (0.8-1.2 mm bites) or small-bite (0.5-0.8 mm bites) technique with Monomax® or PDS® sutures USP 2-0 or USP 1. The suture to wound length (SWL) ratio had to exceed 4:1. After suturing, the tissues were subjected to repetitive cyclic loading on a validated bench test. Results: We found that regardless of technique and material thickness, secure closure of median abdominal wall incisions is feasible by suturing. In larger defects, the small bites technique using Monomax® sutures achieves a safer closure compared to PDS® sutures. Conclusion: Based on the results of this experimental study, a tailored standardized closure technique after midline incision of the abdominal wall, including an optional mesh augmentation, is recommended.

6:1 Suture or Wound length ratio with the short stitch technique – a reality check on practicability and short term outcome

Aim: To analyze laparotomy closure of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. Method: Prospective, single centre, non randomised, controlled cohort study on short stitches with a longterm resorbable, elastic suture (material: poly-4-hydroxybutyrate) aiming at a 6:1 suture to wound (SL/WL) length ratio in midline and transverse, primary &amp; secondary laparotomies for elective &amp; emergency surgery. Results: We included 351 patients (♂: 208; ♀: 143), midline (n=194), transverse (n=103) and a combined midline/transverse L-shaped (n=54) incisions. There was no stitch performance quality difference between elective (n=296) and emergency (n=55) operations, while results in the first 150 patients showed a significantly reduced SL/WL-ratio to the following 200 suture closures (SL/WLratio: 5.64±2.5 vs 6.1±2.3, p&lt;0.001). Average SL/WL-ratio in general was better for midline than transverse incision sutures (6.62±2.5 vs 4.3±1.51, p&lt;0.001). SL/WL-ratio varied among the 6 surgeons participating, although results steadily improved and eventually approximated each other. Conclusions: We could show that a 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be significantly performed better in midline than transverse incisions. Transverse incisions should preferably be closed in 2 layers in order to achieve a sufficient SL/WL-ratio equivalent to the median incision. While on an individual level, results varied between surgeons, quality will improve and eventually approximate.

Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review.

Anastomotic leakage after small bowel resection in emergency laparotomy is a severe complication. A consensus on the risk factors for anastomotic leakage has not been established, and it is still unclear if peritonitis is a risk factor. This systematic review aimed to evaluate if an entero-entero/entero-colonic anastomosis is safe in patients with peritonitis undergoing abdominal acute care surgery. A systematic literature review based on PRISMA guidelines was performed, searching the databases Pubmed/MEDLINE, Cochrane Library, and Science Direct for studies of anastomosis in peritonitis. Patients with an anastomosis after non-planned small bowel resection (ischemia, perforation, or strangulation), including secondary peritonitis, were included. Elective laparotomies and colo-colonic anastomoses were excluded. Due to the etiology, traumatic perforation, in-vitro, and animal studies were excluded. This review identified 26 studies of small-bowel anastomosis in peritonitis with a total of 2807 patients. This population included a total of 889 small-bowel/right colonic resections with anastomoses, and 242 enterostomies. All studies, except two, were retrospective reviews or case series. The overall mortality rates were 0-20% and anastomotic leakage rates 0-36%. After performing a risk of bias evaluation there was no basis for conducting a meta-analysis. The quality of evidence was rated as low. There was no evidence to refute performing a primary small-bowel anastomosis in acute laparotomy with peritonitis. There is currently insufficient evidence to label peritonitis as a risk factor for anastomotic leakage in acute care laparotomy with small-bowel resection. The review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.

The Best Closure Technique Without Mesh in Elective Midline Laparotomy Closure.

Introduction: The risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent. The basic of an optimal outcome after midline incision is the appropriate closure technique with or without a prophylactic mesh. The objective of this paper is to critically examine the various closure techniques and, in particular, to present a detailed comparison of the long stitch and short stitch techniques. Method: Based on the available literature, the characteristics of the different closure techniques are described in detail, advantages and disadvantages are compared, and the current status of a practicable recommendation is discussed. Special attention is paid to the criteria of the short stitch technique, such as the suture to incision length ratio, number of stitches and distances, as well as suture material. Results: For elective midline closures, the use of a continuous closure using a slowly absorbable suture material in the small-bites technique with suture to wound ratio of at least 5:1 result in significantly lower risk of complications such as bursting abdomen and less incisional hernia rates compared to the large-bites technique. Conclusion: Based on the present evidence in midline closure after elective laparotomy the small bites technique can be recommended to significantly reduce the rate of incisional hernia.

Intravenous bolus-infusion versus sliding scale of insulin for intra-operative glycemic control in elective laparotomy surgeries

BackgroundThe aim of this study was to assess the bolus-infusion to the sliding scale of insulin approaches, regarding percentage of the operative time with the target capillary blood glucose (CBG) range, total insulin units given to the patients, development of hypoglycemia, and the peri-operative changes in serum potassium (s.k) in elective laparotomy surgeries. Sixty patients, American Society of Anesthesiologists (ASA) physical status II, were randomly divided to either the bolus-insulin infusion (BII) group, or the sliding scale of insulin (SSI) group.ResultsThe intra-operative target CBG range was achieved in both groups, with no statistically significant difference between them. However, in the post anesthesia care unit (PACU), the number of patients who achieved the target CBG range was significantly more in the BII group. The decrease in the CBG was statistically significant in the SSI group than in the BII group; starting from 30 minutes after the initial intra-venous (IV) insulin injected, to 240 minutes intra-operatively and in the PACU. No patient in either groups developed hypoglycemia. The mean intra-operative time needed to achieve the target CBG range was statistically significant less in the SSI group. The mean percentage of the operative time with the target CBG range was statistically non-significant higher in the SSI group. The mean total insulin units given were statistically non-significant higher in the SSI group. The peri-operative changes in s.k were statistically non-significant between the two groups.ConclusionsThe BII approach slowly achieved the target CBG range intra-operatively and maintained this target in the PACU, with mean 54.6 ± 28.9% operative time with the target CBG range, and with less mean total insulin units needed than the SSI approach.

Incisional hernia rates following midline laparotomy in the obese patient: a retrospective review.

Incisional hernia is the most common complication of midline laparotomy. Although obesity is a known risk factor, the incidence of hernia formation in obese patients is not well defined. We sought to define the rate of incisional hernia formation in obese patients undergoing primary midline laparotomy in a large academic medical center. Obese patients (BMI ≥ 30kg/m2) who underwent an elective or urgent primary midline laparotomy from 2017 to 2021 at our institution were retrospectively identified. A blinded hernia surgeon reviewed imaging to assess for incisional hernia formation, defined as a midline fascial defect with intra-abdominal contents herniated outside of the peritoneal cavity. A total of 2241 patients met inclusion criteria. Cross-sectional imaging was available for 914 (41%) of these patients. The median BMI for all patients was 34.3kg/m2 (range 30.0-59.1). Median time to follow-up imaging was 316days (181-957, IQR = 185) for all patients and 316days (201-903, IQR = 184) for patients with incisional hernia. In total, 474 (51.9%) had radiographic evidence of an incisional hernia. Colorectal and General Surgery demonstrated the highest rate of incisional hernia (p < 0.001). During the study period, 138 patients (15.1%) underwent surgical repair of their hernia at our institution, with the highest percentage being Colorectal Surgery patients. There is a high rate of hernia formation and subsequent hernia repair in obese patients undergoing midline laparotomy. Most importantly, these findings demonstrate an immediate and pressing need to identify the patient risk factors and technical issues related to this rate of hernia formation.