Laparotomy Incision Research Articles

The complications of wound healing on two laparotomy closure techniques in West African Dwarf (WAD) goats undergoing omentopexy

Researchers differ on the complications of wound healing using different laparotomy closure techniques. This study investigated the complications of wound healing when peritoneum was and when it was not incorporated in laparotomy closure in omentopexed WAD goats. Twenty WAD bucks were assigned into four groups. Left-flank-oblique-laparotomy was performed in all the goats. In group A goats, the peritoneum was incorporated in the internal abdominal oblique muscle sutures during laparotomy closure. In group B goats, the peritoneum was not incorporated in the muscle sutures during laparotomy closure. In groups C and D, omentopexy was performed and the laparotomy incision closed as in groups A and B respectively. On post-surgery- day (psd) 14, laparotomy was performed in 4 goats from each group, caudal to the initial left oblique-laparotomy, for examination of the sites for tissue adhesions. Serosanguinous exudation observed in goats in groups A and C stopped on psd 6 while that of groups B and D stopped on psd 8. The severity of behavioural signs of pain in each group was recorded using Numerical Rating Scale. Peritoneum-omentum and muscle-omentum adhesions were observed in 50% of goats in group B. 100% and 25% of goats in group C had peritoneum-omentum and rumen-peritoneum adhesion respectively. In group D, 100% of the goats showed peritoneum-omentum adhesion while 50% exhibited other complicated rumen adhesions. In conclusion, incorporating peritoneum into muscle sutures during laparotomy closure in omentopexed WAD bucks has less complications of wound healing than when the peritoneum is not incorporated in the muscle sutures. Keywords: Laparotomy closure; wound complication; peritoneum suture; West African Dwarf Goat

Clinical Experience of Mini-Open Hepatectomy to Aid a Laparoscopic Approach: A Case Series

Introduction Laparoscopic surgery is recently becoming widespread in the area of liver treatment. However, mobilization of the liver is difficult using laparoscopy alone because of its volume and weight. Ensuring a wider visual field and controlling blood loss are also difficult. We used a hybrid approach involving direct vision and laparoscopy for performing hepatectomy through a small incision to overcome these problems. Case Presentation Mini-open hepatectomy was performed on 64 patients between January 2010 and December 2013. Mobilization of the liver was performed using the smallest possible laparotomy incision. Detachment of right or left triangular ligaments was done using laparoscopy because direct vision of the operation field was impossible. Hepatectomy was performed through a small laparotomy incision. Most operations (47%) involved partial resections. Of these, segmentectomies were performed on 20 patients, whereas lobectomy was performed on 7 patients. The median intraoperative bleeding was 565 mL, and the operative time was 247 minutes. The median postoperative hospital stay was 14 days. There was no postoperative mortality. Conclusion We present the clinical use of mini-open hepatectomy to aid the laparoscopic approach with satisfactory short-term results.

Negative Pressure Dressings (PICOTM) on Laparotomy Wounds Do Not Reduce Risk of Surgical Site Infection.

Background: Surgical site infection is a common cause of post-operative morbidity. Although a number of studies on negative pressure dressings including PICOTM (Smith & Nephew, St. Petersburg, PL) have shown reduced rates of surgical site infections (SSI), more evidence is required. This study sought to determine if PICO dressings reduce surgical site infections or other surgical site complications in primarily closed laparotomy incisions after clean-contaminated surgery in moderate-risk patients. Methods: Patients undergoing laparotomy and bowel resection were randomly assigned to PICO or conventional dressings. The incision was assessed one-week post-operatively for any infection. Patient notes including outpatient appointments were later examined for any delayed infection during the same or subsequent admissions or in the outpatient setting. Patient characteristics such as body mass index (BMI), incision depth, and comorbidities were noted to identify any group who may show more benefit from the negative pressure dressings. Results: From March 1, 2015 until September 30, 2017, 217 patients consented to participate in the trial. Twenty-nine were subsequently excluded, leaving 188 patients with 96 receiving PICO and 92 receiving a standard dressing. Twenty-seven (14%) patients developed a surgical site infection; 13 received a PICO dressing and 14 received standard dressing (p = 0.73), indicating no difference in surgical site infections between the two types of dressing (odds ratio [OR] 1.1). Thirty-one (16.5%) patients developed other surgical site complications. Eleven of these patients received a PICO dressing and 20 received the standard dressing (p = 0.06, OR 2.1). Conclusion: This study does not support the routine use of PICO dressings on uncomplicated laparotomy incisions in moderate-risk patients.

Risk factor analysis of perioperative complications in patients with radical gastrectomy for gastric cancer

Objective: To identify the risk factors of perioperative complications after radical gastrectomy for gastric cancer. Methods: A retrospective case-control study was performed. Case inclusion criteria: (1) patients undergoing radical gastrectomy (D2); (2) primary gastric cancer without distant organ metastasis confirmed by postoperative pathology; (3) no neoadjuvant chemotherapy before surgery. Patients with peritoneal tumor dissemination found during operation, undergoing palliative operation due to distant metastasis, and undergoing combined organ resection and those without complete clinicopathological data were excluded. According to the above criteria, 426 patients with gastric cancer at our department from January 2015 to June 2017 were included in this study. Of 426 patients, 285 were male and 141 were female with a mean age of (55.4±9.7) years. According to the "Japan Clinical Cancer Research Group (JCOG) classification criteria for postoperative complications of gastric cancer", patients with grade II and higher complications were classified as complication group, and patients with no complication or grade I complication were classified as non-complication group. Baseline data were compared between two groups. Associations of perioperative complication with gender, age, body mass index, preoperative routine laboratory test, American Society of Anesthesiologists (ASA) classification, activities of daily living (ADL) assessment, past medical history as well as preoperative conditions (hypertension and/or diabetes), surgical resection procedure, incision type, operation time, intraoperative blood loss/body mass ratio were examined. Univariate analysis was performed using χ(2) test and the Wilcoxon rank sum test to screen the statistically significant variables associated with perioperative complications. The significant variables were included in multivariate logistic regression analysis to identify risk factors of perioperative complication. Results: Grade II or higher complications after surgery were developed in 97 patients (22.8%), which included anastomotic leakage in 18 cases (4.2%), postoperative bleeding in 9 cases (2.1%), abdominal abscess in 5 cases (1.2%), intestinal obstruction in 5 cases (1.2%), pancreatic leakage in 1 case (0.2%), and other adverse events in 59 cases (13.8%). Univariate analysis suggested that the gender, age, ADL, incision type, intraoperative blood loss/body mass ratio, and operation time were associated with perioperative complication (all P<0.05). Multivariate analysis revealed that elder age (OR=1.033, 95% CI:1.013-1.053, P=0.013), incision type of laparotomy (OR=2.091, 95% CI:1.247-3.508, P=0.004), longer operation time (OR=1.004, 95% CI:1.001-1.007, P=0.001) and higher ratio of intraoperative blood loss/body mass (OR=1.100, 95% CI: 1.039-1.163, P=0.031) were risk factors for postoperative complications. Conclusion: Attention should be paid to those cases with elder age, laparotomy incision, longer operation time and higher ratio of intraoperative blood loss/body mass, and perioperative management after gastrectomy should be improved.

Rumen cannulation of sheep by Hecker method - a case study

A modified fistulation technique described by Hecker in 1969 was adopted for the first time in Sri Lanka in sheep, in order to establish a cannulated rumen fistula. Pre-operative procedures included administration of tetanus toxoid 14 days prior to surgery, withholding feed and water for twenty-four hours, Vitamin B-complex and antibiotic injections on the day prior to surgery, and preparation of the left flank region for surgery. Immediately prior to the surgery parenteral analgesic injection was administered and left para-vertebral nerve block was performed. The rumen wall was exteriorized through a laparotomy incision and a metal clamp was applied. Simple interrupted sutures were placed using nylon through the skin, rumen wall and the clamp. After 7 – 9 days the exteriorized rumen wall sloughed off leaving a fistula. A tight rubber cannula was inserted through the fistula and the cannula was closed with a ring and stopper. The antibiotic and analgesic were repeated post-operatively for three days. The cannulated animals were used for a one-year research project and the animals were clinically normal throughout the project.

Short-term influences of radiation on musculofascial healing in a laparotomy rat model

Preoperative radiation is associated with an increased risk of wound complications. However, the influences of radiation on musculofascial wound healing remains unclear. The purpose of the study was to investigate the short-term effects of preoperative local radiation on the musculofascial healing of laparotomy incisions in a rat model. Eighteen Fischer 344 rats received radiation doses of 0, 10, or 20 Gy to the abdominal wall and underwent laparotomy 4 weeks later. Two weeks after laparotomy, samples of irradiated muscle were harvested for mechanical tests, histological (Hematoxylin & Eosin, and Masson’s Trichrome) and immunohistochemical analyses using KI67, CD31, TGF-β, and MYOD1 antibodies. The elastic modulus (EM), maximum strain (MS), and ultimate tensile strength (UTS) in the 20-Gy group were significantly weaker than those in the 0-Gy group. The EM and UTS in the 20-Gy group were significantly lower than those in the 10-Gy group. The UTS and MS in the 10-Gy group were significantly lower than those in the 0-Gy group. The mean number of inflammatory cells per mm2 in the 20-Gy group was significantly larger than those in the 10- and 0-Gy groups. The mean numbers of CD31-, KI67-, and MYOD1-positive cells, the optical density of TGF-β, and the microvessel density in the 20-Gy group were significantly smaller than those in the 10- and 0-Gy groups. These results indicated that radiation delays musculofascial healing and decreases mechanical strength of the laparotomy incision by creating a chronic inflammatory environment, inhibiting cell proliferation, angiogenesis, granulation maturation, collagen deposition, and muscular regeneration in a dose-dependent manner. The impaired biomechanical, histological and molecular properties may be associated with the higher risk of wound complications in patients who undergo radiotherapy prior to laparotomy.

2019 Canadian Surgery Forum Abstracts.

# 01. The future of general surgery training: a Canadian resident nationwide Delphi consensus statement {#article-title-2} Various pedagogical models have been introduced in an attempt to improve and restructure surgical training, but significant obstacles remain. Before implementing national

Mean Post Operative Pain Score in Midline Laparotomy Incisions Made using Scalpel VS Monopolar Diathermy

OBJECTIVE: To compare mean post-operative pain score in midline laparotomy incisions made usingscalpel versus mono-polar diathermy.METHODOLOGY: Present study was Randomized Controlled trial conducted at Department of Surgery,Dr. Ruth Katherina M. Pfau Civil Hospital Karachi from July 2016 to June 2017. A total 80 patients wererandomly divided in two equal groups. Group A patients underwent exploratory laparotomy with scalpelwith disposable blade while Group B with monopolardiathermy in cutting mode. Postoperatively painscore was measured using Visual Analogue Scale.RESULTS: Mean age was 31.45±9.69. Mean pain score on post operative day 1 was 8.60±0.92 in group A(Scalpel) and 5.98±0.26 in group B (Diathermy). Mean pain score on day 2 and 3 was 7.25±0.8 vs 3.80±0.9and 5.5±0.6 vs 2.7±0.8 in group A and B respectively. P-value was found to less than 0.001 and thereforegreatly significant.CONCLUSION: The findings of this study show that incision made by diathermy is safe and effective interms of post-operative pain as compared to scalpel incision.

Gluteal Flaps Revisited: Technical Modifications for Perineal Wound Reconstruction.

Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity. A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed. A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11). This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.

Suture length to wound length ratio in 175 small animal abdominal midline closures.

Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.

Effect of Adding Dexmedetomidine to Bupivacaine in Ultrasound Guided Rectus Sheath Block: A Randomized Controlled Double-blinded Study

Background: Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal. Objective: The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision. Methods: Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia. Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used. Results: A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.

Incisional negative pressure wound therapy does not reduce surgical site infections in abdominal midline incisions: a case control study

Purpose: There is evidence from various surgical specialties that incisional negative pressure wound therapy (iNPWT) might reduce postoperative surgical site infections (SSIs). In visceral and general surgery, there is varying evidence of its efficacy in reducing surgical site infections.Methods: A prospectively registered patient cohort of 43 patients with abdominal wall and visceral surgery received treatment with iNPWT and was compared to a matched retrospective cohort to analyze its effects on SSI occurrence and respective risk factors. Groups were matched by procedure, sex, body mass index and age. We used two different systems of iNPWT: (i) PREVENATM or (ii) self-made epicutaneous iNPWT from common VAC material.Results: We could not find a total reduction in postoperative SSIs by application of iNPWT. But within the iNPWT cohort, patients with self-made iNPWT suffered more often from SSIs compared to the commercial iNPWT subgroup. No patient specific risk factors could be identified to advocate the use of iNPWT.Conclusion: Our data do not support the use of an incisional negative pressure wound therapy on closed wounds in midline laparotomy incisions. Although, differences exist between the commmercial and self-made systems.

Surgical factors affecting superficial surgical site infections in laparotomy incisions

Surgical factors affecting superficial surgical site infections in laparotomy incisions

Risk Factors of Burst Abdomen in Emergency Laparotomy

Burst Abdomen is a preventable condition in which many risk factors play their role and lead to life threatening complications. This study was carried out to find out various risk factors of burst abdomen following emergency laparotomy, to find out the high risk group of patients for burst abdomen, to determine the predictors of burst abdomen, to prevent the rate of burst abdomen &amp; find out morbidity and mortality of burst abdomen. This cross sectional study was done among 100 cases of burst abdomen occurring in Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka and Dhaka Medical college,Dhaka during the period of July,2011 to December,2011. The patients were admitted for various surgical problems and underwent emergency laparotomy. Burst abdomen was taken into account. Another group of 100 patients who undergone emergency laparotomy but did not develop burst abdomen were also taken into account to make a comparison with the burst group. Patients who undergone elective laparotomy,paediatric age group,patients undergone exploration through mini laparotomy or transverse incision,patients with pregnancy were excluded from the study populations.Patients were assessed by history taking, examination and appropriate investigation before surgery and observed post operatively for any complication. The results were prepared on 100 patients underwent emergency laparotomy in SSMCMH &amp; DMCH. Burst abdomen following emergency laparotomy results from multifactorial causes. The main outcome measure found significant as the risk factors of burst abdomen in this study were peritonitis (95%),anaemia (26%),malnutrition (18%), in the preoperative period; inadequate peritoneal toileting and faulty surgical techniques in the per operative period; and wound infection (62%), postoperative cough (28%), abdominal distension (22%). The result also shows that the rate of burst abdomen is still very high in SSMCMH &amp; DMCH and most of them occur in operations done by trainee surgeons (86%) and in those patients who has 3 or more of the risk factors (44%). We hope this study will arouse awareness and concern about this problem, so that more active steps will be taken for its prevention by identifying the high risk groups. This will certainly reduce the incidence of burst abdomen.&#x0D; Bangladesh Med J. 2017 May; 46 (2): 38-42

Emergency surgery for a Morgagni hernia causing respiratory failure

Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s general condition improved thereafter, and he was discharged on postoperative day 29.

Comparative randomized controlled clinical trial of diathermy versus scalpel incision in midline laparotomy

Background: Laparotomy incisions have traditionally been made using a scalpel. Diathermy, a latest technique, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that diathermy may offer likely advantages with respect to blood loss, incision time and postoperative pain. The aim of this study was to compare the efficacy and safety of surgical diathermy incisions versus conventional scalpel incisions for midline laparotomy in our hospital with an aim to evaluate diathermy as an operational alternative to scalpel incision.Methods: This was a prospective randomized clinical study which was conducted in the surgical wards of Medical College &amp; SSG hospital, Vadodara, between December 2013 and December 2014. Patients were randomly assigned to two groups i.e. Group A (scalpel group) and Group B (diathermy group).Results: A total of 148 patients were enrolled in the study. Of these, 74 patients were randomized to Group A (scalpel group) and 74 patients to Group B (diathermy group). The two groups did not vary significantly in relation to age and sex (p&gt;0.001). Laparotomy skin incisions using diathermy were significantly quicker than scalpel incisions (p=0.624). There was significantly less blood loss in the diathermy group compared with the scalpel group (P=0.15). The mean visual analogue scale was significantly reduced more in the diathermy group than in scalpel group patients on postoperative day 1 (p=0.81), day 3 (p=0.71) and day 5 (p=0.79) respectively. Postoperative complication rates did not differ significantly between the scalpel and diathermy groups (p=0.624).Conclusions: We concluded that diathermy incision in midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and postoperative wound infection.

Management and outcome of patients with gastrointestinal cutaneous fistula in Al-Karama teaching hospital

Background: Gastrointestinal cutaneous fistulae are abnormal communication between stomach, small or large bowel, and the skin allowing the gastrointestinal contents to flow onto the skin. It is one of the most dreaded postoperative complications. It is a major cause of morbidity and possible mortality especially in high output fistulae. The aim of this study was to assess the pattern of postoperative gut fistulae particularly on the clinical presentation, diagnostic, work up, managements, and outcomes.Methods: It was a prospective non-randomized study of 52 consecutive patients collected in three and half years (from 1st January 2015 to 1st June 2018) in Al-Karama Teaching Hospital. The study involved patients who had postoperative fistula in the anterior abdominal wall. Originating from the digestive tract. All the patients were subjected to history and physical examination according to a data collection sheet.Results: There were 32 males and 20 females mean age 40.96 and the mean hospital stay (14-45) days. Author found that 42.3% of cases were due to malignancy, around 30.7% were presented following laparotomy for trauma, three cases (5.8%) is due to surgery for inflammatory bowel disease (total colectomy), and 21.2% were due to miscellaneous. Regarding site of fistula, fourteen cases had single fistulae draining from midline laparotomy incision (26.9%). ten cases (19.3%) were miscellaneous conditions. Wound dehiscence and wound infection occurred in four cases (7.7%). Multiple Organ Failure (MOF) occurred in three cases and led to death.Conclusions: Trauma and malignancy made the major two causes of postoperative fistulae in this study. The higher output fistula, the more incidence of complications, such as sepsis, electrolyte disturbances, skin excoriation and weight loss.

Establishment of a Rabbit Model of Giant Abdominal Wall Hernia.

Animal models play an important role in abdominal wall hernia research. However, there is still no standard animal models for abdominal wall hernia. This study aimed to introduce a novel rabbit model of giant abdominal wall hernia. Sixteen 1-year-old New Zealand rabbits weighing 3 to 5 kg were used. After general anesthesia, a 5-cm longitudinal incision was made 2 cm lateral to the ventral midline, and a full-thickness laparotomy incision was made en bloc including the peritoneum (except skin). A full-thickness defect of the abdominal wall with a diameter of 3 cm was created. To increase the intraabdominal pressure, constipation was induced by deprivation of water perioperatively. The development of giant abdominal wall hernia was recorded. The bulge area of these rabbits was redissected to assess the hernia 3 months postoperatively. Of the 16 rabbits, 13 (81.25%) rabbits had grade I healing and 3 (18.75%) rabbits had grade III healing. Reversible abdominal bulge at the incisional site was observed in all rabbits 3 to 18 days postoperatively. The average maximum diameter of the bulge was 8.73 ± 1.00 cm. Redissection of the bulge area showed successful establishment of giant abdominal wall hernia. We successfully established a rabbit model of giant abdominal wall hernia, which may provide an easy-to-use tool for the research of abdominal wall hernia.

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

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.