Laparotomy Wound Research Articles

Granulation tissue morphology of the laparotomic wound with different types of sutures

The aim — to study experimentally the granulation tissue morphological features of the laparotomy wound after suturing it by simple knots and continuous wrapping sutures.Materials and methods. The experiment was performed on 108 rats undergoing a median laparotomy. The first group of animals (54 rats) edges of the musculoaponeurotic layer of the anterior abdominal wall were connected by simple sutures and in the second group (54 rats) by continuous wrapping. A sampling of biological material was performed on the 1st, 7th and 14th days after surgery, by excision of the musculoaponeurotic layer of the anterior abdominal wall along with the skin.Results and discussion. On the 1st day of the study, in the first group, lymphoid cells and neutrophils statistically significantly prevailed in the granulation tissue, the difference between their number was statistically insignificant.The second group of animals is likely to have a higher percentage of lymphoid cells only. At the 7th and 14th days of observation, the percentage of fibroblasts in the granulation tissue of animals of both groups probably prevails. On the 1st day after surgery, fibrin is observed in both experimental groups of animals, in the form of a grid, and in the second experimental group, there are still hemorrhages. The morphology of the laparotomy wound granulation tissue for the 14th day of observation does not differ when applying a simple knot and continuous suture, except that the latter is likely to be dominated by the specific volume of collagen fibers.Conclusions. The use of continuous suture, unlike simple knots, on the 14th day after suturing of the laparotomy wound lead to a probable increase in the percentage of fibroblasts, a decrease in macrophages, as well as a predominance of the specific volume of collagen fibers, indicating a relatively rapid maturation of the tissue.

Gender abdominal features, determining depth of incisional wound in abdominal surgeries

Aim. To determine the mean values of the anterior abdominal wall thickness and abdominal cavity depth for men and women with different types of constitution and reveal the mechanisms, allowing the surgeon to predict these parameters in the preoperative period.
 Materials and methods. One hundred twenty male and female computer tomograms of the abdominal cavity were studied.
 Results. The anterior abdominal wall thickness and abdominal cavity depth values for men and women with different types of constitution at different levels of measurement were determined. The depth of laparotomy wound was found to be dependent on the distance between the anterior upper iliac spines.
 Conclusions. The gender features of the anterior abdominal wall thickness and abdominal cavity depth were revealed. There were determined the coefficients, permitting to predict the depth of laparotomy wound in the preoperative period.

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.

Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.

Abdominal skin metastasis in endometrial cancer

Objectives: Surgical wound metastases in stage 1 endometrial cancer are possible, with a variety of different pathophysiological possibilities. Comprehensive management is needed to keep the patient on the possibility of a good prognosis.Cases Report: During January 2015 – January 2018 at dr. Soetomo Hospital, there were 2 cases of metastatic endometrial cancer in the laparotomy wounds by which the condition is very rare. Case 1, The patient was diagnosed with endometrial carcinoma following the results of curettage. Anatomical pathology examination was done and obtained grade 2 endometrioid adenocarcinoma. In Case 2, the patient underwent Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy in 2013 at Mojokerto General Hospital, indicating Uterine Fibroids and Ovarian Cysts. The results of anatomical pathology examination were unknown. On April 2017, the patient complained abdominal swelling since 3 months ago.Conclusion: In January 2015 - January 2018, 2 cases of metastatic endometrial cancer was found in a former laparotomy operation where this condition is very rare in endometrial cancer cases with low grade ,so that follow-up, monitoring and more vigilance are required in patients with low-grade endometrial Ca who have finished undergoing a surgery and chemotherapy. Rapture or mass resection, followed by external radiation, may be performed in patients with recurrence in the laparotomy wound area or in patients with high risk factors for endometrial cancer such as a history of estrogen use, tamoxifen, nullipara, obesity, diabetes mellitus, and family history of endometrial cancer. Currently, there is no fixed procedure (guideline) in RS. Dr. Soetomo to overcome recurrences especially in the scars of cancer surgery.

A prospective study in peritonitis patients to compare the impact of subcutaneous negative suction closure, conventional primary closure of skin and subcutaneous tissue and open skin technique following laparotomy

Background: Abdominal wall closure in the presence of sepsis presents a challenge to the surgeon. The objective of this study is to determine the advantages and disadvantages of each method to individualise the techniques based on patient profile about surgical site infection, duration of hospitalisation and morbidity.Methods: A prospective comparative study was conducted among 102 operated patients of peritonitis in the Department of General Surgery at St John’s Medical College and Hospital. The patients were divided into three groups, group A, group B and group C. In group A, skin and subcutaneous tissue was closed after draining the subcutaneous space by a negative-suction drain. In group B, the patient’s skin and subcutaneous tissues were closed primarily with continuous sutures without negative suction drain. In group C, the laparotomy wound was closed and the skin was left open. And the outcome compared in the form of wound infection, hospital stay and morbidity. Patients on immunosuppressive therapy and paediatric patients were excluded. Demographic and clinical variables were recorded at the time of admission. SPSS version 18 was used for analysis.Results: The study showed male preponderance and the mean age was 43.2 years. Duodenal perforation was the commonest cause of peritonitis in this study (38.2%). Incidence of surgical site infection was less in Group A (20.6%) compared to group B (52.9%) and group C (29.4%). Duration of hospital stay was also less in Group A patients (9.3±3.6 days) compared to other two groups. 37 patients who were included in the study were diabetic, out of which 25 patients (67.6%) developed surgical site infection.Conclusions: It can be concluded from this study that abdominal wall closure using a sub cutaneous negative suction drain in peritonitis cases reduces the incidence of surgical site infection, duration of hospital stays, subsequent surgeries related to wound dehiscence and its associated morbidity.

Impact of a Dual-Ring Wound Protector on Outcome After Elective Surgery for Colorectal Cancer

BackgroundThe impact of dual-ring wound protectors (DRWPs) on the long-term outcomes of patients with colorectal cancer (CRC) undergoing elective surgery remains unclear. The aim of this cohort study was to compare short- and long-term outcomes after CRC resection with or without use of a DRWP. MethodsThis study enrolled 625 patients with stage I–III CRC undergoing curative resection and divided them into DRWP (n = 348) and control (n = 277) groups. Primary endpoints were postoperative short- and long-term complications. Secondary endpoints were oncological outcomes including wound recurrence, disease-free survival, and overall survival. ResultsRates of postoperative complications (P = 0.004) and laparotomy wound infection (LWI) (P < 0.001) were markedly lower in the DRWP group. Operation quality, as per the number of lymph nodes harvested and rate of R0 resection, did not differ between the groups (all P > 0.05). The DRWP group exhibited significantly lower rates of incisional hernia occurrence (5.3% versus 9.5%, P = 0.045) compared with the control group. Multivariable analyses demonstrated an increased risk of LWI with no wound protector in colorectal surgery (odds ratio, 3.778; P = 0.001), and patients who developed LWI after surgery were more than 4 times more likely to develop an incisional hernia during outpatient follow-up (odds ratio, 4.333; P = 0.001). One patient in the control group (0.36%) had isolated wound recurrence at 12 mo postoperatively. ConclusionsFewer postoperative and late complications, comparable oncological safety, and similar long-term clinical outcomes confirmed the benefits of DRWP use for patients with CRC undergoing elective surgery. Therefore, the use of DRWP may be considered in curative CRC resection.

Application of combined technique for laparotomy wound closure in urgent surgery

Aim. To improve the results of patients’ treatment after midline laparotomy by reducing the number of the postoperative ventral hernias and eventrations.&#x0D; Materials and methods.There were examined 111 urgent patients, operated through the median laparotomic approach. The main group included 48 persons, for whom,on completion of intervention,the white line was sutured with a chess-staggered suture(patent of RF № 2644846, 14.02.18). In the control group, for median aponeurosis interrupted sutures were used.&#x0D; Results. In the early postoperative period, in the control group there were 2 (3 %) eventrations, in the main group – no eventrations. After one year of observations, in the main group – 3 (6 %) patients with aponeurosis defects by the postoperative scar USI and 2 (4 %) patients with hernias were found out. In the control, one year after the surgery, there were 6 (9.5 %) aponeurosis defects and 5 (8 %) postoperative hernias.&#x0D; Conclusions. Application of interrupted chess suture in combination with staggered sutures is the way to prevent eventrations and postoperative ventral hernias in urgent surgery.

Total prostatectomy combined with urethral anastomosis in a dog: a case report

Prostate cancer is the most common prostate disease diagnosed in castrated dogs. However, prostate cancer is considered to be quite rare in dog population. The presence of prostate tumours can lead to urethral obstruction. Other clinical signs include asymmetric, painful, hard growths on rectal examination, neurological deficit or lameness of the pelvic limbs and general symptoms such as anorexia, weight loss or difficult urination. The neoplastic process may spread to the neighbouring organs and give metastases to the lymph nodes, lungs and skeletal system. Patient with histopathologically confirmed prostate cancer should be examined for metastases. The prognosis is usually unfavourable because of late diagnosis and the presence of metastases. Therapeutic options include surgery, chemotherapy and radiotherapy. Complete prostatectomy carries with it many complications and often requires osteotomy of pelvic fusions. For that reason, total prostatectomy is not commonly performed in companion animals; however, it should be considered in cases of early detection with the absence of metastases. This report presents the procedure of a complete prostatectomy in a dog with a pre-pubic anastomosis of the urethra, without osteotomy of the pelvic septum. The anastomosis of the urinary tract was placed outside the abdominal cavity, caudally from the laparotomy wound. The presented technique seems to be appropriate for the treatment of malignant tumours of the prostate gland in dogs.

Impact of Pressurised pulse jet wound irrigation with Normal saline in Laparotomy wounds on Surgical site infections in comparison with standard wound irrigation techniques: A prospective trial

Impact of Pressurised pulse jet wound irrigation with Normal saline in Laparotomy wounds on Surgical site infections in comparison with standard wound irrigation techniques: A prospective trial

HugeNon-Organ Retroperitoneal Tumor inCombination with aCystoma of Uterine Appendages

The article describes the experience of successful diagnostics and treatment of giant non-organ extraperitoneal tumor combined with a cystoma of uterine appendages.Patient P., 43 years old, was hospitalized in the oncology department, diagnosed with “Abdominal tumor, right ovary?” The state was satisfactory, after palpation of the abdomen, a lumpy formation of a densely elastic consistency, from the womb to the epigastric region, was found. An ultrasound revealed a homogeneous tumor formation 30×28 cm from the border of the uterus to the liver. When performing median laparotomy, a dumbbell-shaped tumor (36×26×20 cm) was found in the retroperitoneal space with involvement of the mesentery of the small intestine, lower horizontal portion of the duodenum, mesentery of the transverse colon, superior mesenteric vessels, aorta and jejunum. In the right appendages, a cystoma 12–15 cm in diameter was found, with inversion and necrosis. Adnexectomy was performed. An express lymph node biopsy revealed cells suspicious for malignancy. The tumor was mobilized and removed as a single unit with retroperitoneal tissue, lymph nodes in combination with resection of 70 cm of the jejunum and fenestrated resection of the duodenum. The resulting gut defect 9×7 cm was sutured with a precision single-row suture. Inter-intestinal anastomosis “endto-end” was formed. Nasointestinal intubation was performed. The abdominal cavity was sutured, and two tubular drainages were installed. The postoperative period was uneventful. The histological conclusion: fibrous histiocytoma of the mesentery of the intestine with malignancy in the center of the node, in the ovary – total hemorrhagic infiltration of all layers, edema. The tumor conference consultation was recommended. After 1.5 years, the patient was admitted with the same clinical picture. During laparotomy, a tumor recurrence was discovered, the nodes of which were located in the retroperitoneal space, in the abdominal cavity with invasion to organs and large vessels. The case was recognized as inoperable, the laparotomic wound was closed completely. Sixteen days after surgery the patient was discharged.

Role of subcutaneous drain in class III and class IV laparotomy wound

Background: Surgical site infections (SSI) are major problem in general surgery. Aim of this study is to know the role of subcutaneous conrrugated drain in class III and IV laparotomy wounds.Methods: Comparative study was done in 100 patients of emergency laparotomy in civil hospital, Gandhinagar from January 2014 to December 2016.Results: Incidence of surgical site infections were significantly lower (16%) in patients with subcutaneous drain, compared to 40% in patients without drain (p value 0.01).Conclusions: Corrugated subcutaneous drain is cost effective way of reducing surgical site infections and subsequent morbidities in class III and IV laparotomy wound.

THE ROLE OF LAPAROTOMIC WOUND INFECTION IN THE FORMATION OF PLANE VISCERAL AND PARIETAL ADHESIONS AND THE DEVELOPMENT OF ABDOMINAL ADHESIVE DISEASE IN THE TREATMENT OF ADVANCED PERITONITIS

The aim is to identify the connection between the presence of peritoneum adhesions and the laparotomic wound healing, as well as to find a way to prevent the adhesive disease.Materials and methods. The treatment of 149 patients with purulent peritonitis in the main and control groups was performed. In the main group, the laparotomic wounds were sutured by removable draining muscular aponeurotic sutures. In the control group, the laparotomic wounds were sutured with monofilament interrupted sutures in layers, with the edges of the dissected peritoneum being seized into the aponeurotic suture.Results. The suppurations of laparotomic wounds in the control group were 34.7%. In the main group, where the laparotomic wounds were sutured with removable draining muscular aponeurotic sutures (RDMAS), the suppuration occurred only in one patient (2.2%). The abdominal adhesive disease was observed in 19.4% cases in the control group, with 4 patients (2.0%) having been operated. In the main group, only 2 cases (4.3%) of the abdominal adhesive disease treated without surgical intervention were detected.Conclusion. One of the main causes of the postoperative abdominal adhesive disease with advanced peritonitis is the suppuration of the laparotomic wound. The use of RDMAS during the surgical treatment of advanced purulent peritonitis not only prevents the suppuration of laparotomic wounds, but also significantly reduces the development of all types of adhesive disease caused by visceral and parietal peritoneal adhesions.Conflict of interest: the authors declare no conflict of interest.

Prophylactic Negative Wound Therapy in Laparotomy Wounds.

Prophylactic Negative Wound Therapy in Laparotomy Wounds.

A comparative study on surgical site infections after primary closure and delayed primary closure in clean contaminated laparotomy cases

Background: Surgical site infection is a significant cause of post operative morbidity. Timing of skin closure following a surgery and its relation to incidence of infection has been studied. The debate whether primary or delayed primary closure have been around for a long time. The aim of this study is to compare the rate of infection in a laparotomy wound in clean contaminated laparotomy cases after primary and delayed primary closure.Methods: 132 patients who underwent laparotomy for clean contaminated were selected. Of this primary closure of the skin was done in 66 cases and delayed primary closure at 48 hours were done in the other 66 patients. Wounds were followed up till post op day 7. The results between two groups were compared using chi square test.Results: two out of 66 cases developed SSI in the delayed primary sutured group whereas 8 out of 66 cases developed SSI in primary suturing group. The results were compared using chi square test and the chi square statistic was 3.8951 and the p value is 0.048428 (&lt;0.05) proving the result significant.Conclusions: The incidence of surgical site infection in laparotomy wound after a primary closure was higher compared to delayed primary closure in clean contaminated laparotomy wounds and the difference is significant based on statistical evaluation.

Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy

Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.

Retrospective Analysis of Bacterial Spectrum and Associated Risk Factors in Post-Operative Wound Infection

Introduction Post-Operative wound infection is very interesting for the surgeons since it is considered inevitable in some cases and also very unfortunate. In spite of great sophistication in surgical techniques and recent advances in the microbial studies, the post-Operative wound infection remains to be ever challenging in the daily practice of the surgeon. It is utmost discomfort to the patient, causes delay in resuming work due to disability, decreases the quality of life of the patient and increases financial burden to the patient especially in a resource limited country like ours. This retrospective study conducted in Sharda Hospital, briefly discusses the history and the relevant definition necessary for the discussion of surgical site wound infection, the known postulated risk factors and the profile of causative micro-organisms. Material and Method Hundred cases of laparotomies (emergency and elective) carried out in Sharda Hospital in August 2015 and November 2017 were included in the study and studied retrospectively. Study is based on the clinical observation of the patient. All the patients irrespective of age were included in the study. For the convenience, laparotomy wounds are graded as Grade0-No infection, Grade1-Surgical site erythema, Grade2-Subcutaneus collection, Grade3-Patial burst, Grade4-Complte Burst. Result The incidence of post-operative wound infection was 26%. The percentage of post-operative wound infection increases with the poor nutrition, increasing age, hypo-proteinemia, anaemia, contaminated peritoneum of abdomen, poor chest compliance. The rate of post-operative wound infection is directly proportional to the duration of surgery, longer stay in the hospital. Deranged liver function and kidney function lead to increase incidence of post-operative wound infection. The rate of post-operative wound infection is less in cases where the gastro-intestinal tract was not opened. The most common Infecting organism found was Escheria coli.

Laparoscopic donor right hepatectomy with reconstruction of segment V and VIII tributaries of the middle hepatic vein using a cadaveric iliac artery allograft

Laparoscopic donor right hepatectomy with reconstruction of segment V and VIII tributaries of the middle hepatic vein using a cadaveric iliac artery allograft

A prospective comparative study of efficacy of pulse jet irrigation and conventional irrigation techniques in prevention of surgical site infections in laparotomy wounds

Background: Surgical Site Infections (SSIs) are infections of tissues, organs or spaces exposed by surgeons during performance of an invasive procedure and continue to be a major source of morbidity following operative procedures. Wound irrigation is the steady flow of a solution across an open wound surface meant to remove cellular debris and surface pathogens contained in wound exudates or residue from topically applied wound care products.Methods: This prospective comparative study was conducted to compare the effectiveness of Pressurized Pulse Irrigation (PPI) and Standard Irrigation Technique (SIT) in laparotomy wounds. Duration of the study was for a period of 12 months and included 100 consecutive patients undergoing laparotomy.Results: 13% of patients who underwent laparotomy had SSI out of which 9 patients had superficial infection only. 8% of 50 patients who had PPI developed SSI, whereas 18% of those who underwent SIT had SSI. Though PPI had less incidence of SSI, statistically it was insignificant.Conclusions: The study showed a decrease in the incidence of postoperative SSI in both elective and emergency laparotomy wounds irrigated with PPI compared to SIT, though the study was statistically insignificant since the p value was less than 0.005 with a odds ratio of 2.52. The study results suggested that there was decrease in the incidence of SSI in PPI patients and also that it decreases the postoperative stay, morbidity and cost.

An assessment of clinical, biometric, cosmetic and microscopic outcomes of four suture techniques for cutaneous closure of laparotomy wounds: an experimental study in rabbits

The purpose of this study is to identify a suture technique that provides superior cosmeticoutcomes and proper wound healing for skin closure after midline laparotomy of small animals in a rabbit model This study also attempts to clarify the role of selected four suture patterns in wound healing wound complications cosmetic impacts and histopathology on the laparotomy skin wound Twenty four female rabbits of white New Zealand and California breeds were used for this experimental study Four suture patterns were compared for cutaneous closure of a ndash cm midline laparotomy wound classified as buried continuous subcuticular ndash intradermal BCSID interrupted cruciate mattress ICM running horizontal mattress RHM and far ndash near ndash near ndash far FNNF The different groups were studied in terms of clinical findings wound and suture biometrics cosmetic assessment microscopic examination and statistical analysis RHM presented a lsquo very good rsquo cosmetic grade on a element scale clinically associated with rapid successful wound healing and no complications BCSID was superior in cosmetic terms among the tested groups where it showed an aesthetically lsquo excellent rsquo score However the technique was not efficient enough to prevent wound dehiscence in some cases ICM demonstrated a lsquo very good rsquo cosmetic degree but was not functional enough to prevent invasive contamination or infection in certain instances FNNF was the inferior among all groups in regards to the cosmetic outcomes but was characterized by successful slowly progressive healing Suture to wound length SL WL ratio of all groups seemed to have a correlation with the rate of wound dehiscence as wound dehiscence is unlikely to occur if a SL WL ratio is more than The microscopic results proved that the RHM suture pattern was the favourable technique RHM can be concluded as the suture technique of choice for cutaneous closure of laparotomy wounds in small animals like rabbits It serves as a compromise of high quality cosmesis and optimal wound healing The assessed suture techniques can be graded in a descending order from the superior to the inferior cosmetically as BCSID gt RHM gt ICM gt FNNF and histopathologically as RHM gt FNNF gt BCSID gt ICM Clinical trials are needed to be performed to validate and reproduce the outcomes of this study on canine and feline patients