Laparotomy Wound Research Articles

0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study

IntroductionPatients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration–approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure. MethodsA retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant. ResultsSixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence. ConclusionsIn patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.

СРАВНИТЕЛЬНАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ РАНЕВОЙ БОЛИ С ПРИМЕНЕНИЕМ ТРАНСМЕМБРАННЫХ ТЕХНОЛОГИЙ ПОСЛЕ СРЕДИННОЙ ЛАПАРОТОМИИ

ntroduction. Pain syndrome remains an urgent problem for patients who have undergone median laparotomy in the early postoperative period. The use of modern opioid analgesics, in addition to effectively combating postoperative pain, has a number of negative systemic effects on the body, which requires the search for new methods of analgesia. Aim. To determine the effectiveness of the author’s device using semipermeable membranes for anesthesia of the median laparotomy wound in relation to the relief of pain syndrome in patients who have undergone abdominal surgery, in comparison with classical parenteral analgesia. Materials and methods. We analyzed the intensity of wound pain syndrome in 70 patients underwent a median laparotomy surgery for injuries and acute abdominal surgical diseases. A control group included 35 people. An experimental group had the similar number of patients. The control group received pain relief in the early postoperative period with systemic analgesics – opioid and non-steroidal anti- inflammatory drugs. In the study group, during the operation, the device was implanted in patients retromuscularly according to the author’s method using a semipermeable membrane, through which a transmembrane blockade of the sheaths of the rectus abdominis muscles was carried out with local anesthetics. Results and discussion. Opioid analgesics were not administered to all patients of the study group in the postoperative period due to a mild pain syndrome. Conclusion. The device for analgesia of the median laparotomy wound with the use of a semipermeable membrane provides relief of pain syndrome, which allows abandoning opioids and limiting the use of non-steroidal anti- inflammatory drugs significantly.

MICROBIOLOGICAL CHARACTERISTICS OF THE LAPAROTOMIC WOUND, WHEN COMPLETE EVENTRATION BEGINNING, IN THE ONCOLOGICAL PROCESS

The aim of the study –to study the peculiarities of the qualitative and quantitative compositionof the microflora of the wound exudate of the laparotomy wound, complicated by the eventration,depending on its degree, in patients with malignant neoplasms of the abdominal cavity.Materials and methods.28 patients with malignant neoplasms of abdominal organs who hadpostoperative eventration were studied. The main group consisted of 12 patients who hada complete eventration (grade II-IV). The comparison group was formed by 16 patients whohad subcutaneous eventration (I degree). The collection of biological material was carriedout during the 8th day of the early postoperative period, by bacteriological examinationof the wound exudate, during dressings. Species composition of microorganisms, theirpopulation level, the coefficient of constancy, the frequency of species detection, thecoefficient of significance, the coefficient of quantitative dominance was studied.Results. When eventration II-IV degrees occurs, against a background of the oncologicalprocess, a probable predominance of the number of strains of E. coli, S. aureus and m/o ofthe genus Proteus is noted, and the number of strains of E. coli is likely to prevail during allperiods of observation. During the development of II-IV degrees of eventration, due to theoncological process, in the exudate of the laparotomy wound, there is a probable predominanceof the population level of E. coli, S. aureus and m/o of the genus Proteus. The dominantmicroorganism, according to the determined coefficient of quantitative dominance, at alldegrees of eventration, throughout the entire period of the study, is E. coli, and Enterococcusfaecalis is in the second place. At the same time, at all degrees of eventration, high numbers ofthe coefficient of quantitative dominance in S. aureus are noted on the 6-8th day of the study. &#x0D; Conclusions. With the development of postoperative eventration of II-IV degrees, inpatients with malignant neoplasms of the abdominal cavity, a probable increase in thenumber of strains sown and the population level of microorganisms in the laparotomywound exudate with E. coli, S. aureus and microorganisms of the genus Proteus is noted.In patients with malignant neoplasms of the abdominal cavity, with the occurrence ofII-IV degrees of postoperative eventuration, the dominant microorganisms of the woundexudate are E. coli and Enterococcus faecalis and microorganisms of the genus Proteus.

281 A Review of the Accuracy of Rectus Sheath Catheter Placement Following Laparotomy

Abstract Aim Rectus sheath catheters (RSC) deliver local anaesthetic to post-operative laparotomy wounds. Optimum positioning for RSC’s is in the retro-rectus space. They aim to reduce post-operative pain and have a lower side effect profile than epidural analgesia. This audit reviews positioning of RSC in post-operative laparotomy patients at Northumbria Healthcare Trust. Method NELA patients who had open laparotomy or laparoscopic converted to open procedures between 1st December 2021 to September 2022 were considered for inclusion. Patients who had RSC and had a post-operative CT scan within the first 3 post-operative days were identified. Results 105 patients (68%) had RSC inserted. 11 (10.5%) patients with RSC placed had post-operative imaging within 3 days. CT images were reviewed assessing the position of RSCs. One patient had bilateral RSC correctly placed. Of the total individual RSC’s (22) on imaging, 9 were correctly positioned, 9 incorrectly positioned, and 4 not identified when reviewing CT images. All of those incorrectly positioned were identified in the subcutaneous fat. Conclusions At Northumbria Healthcare Trust, RSC are inserted by surgeons and not ultrasound guided. This audit highlighted that they are mostly placed in the incorrect position. A method of inserting RSC more accurately, such as use of ultrasound under direct vision, may help to improve overall positioning of RSC. Further research is needed to assess if correctly placed RSC would result in lower analgesic requirements and improved post-operative recovery.

1027 Small Bite vs Big Bite Closure Technique in Elective Oesophagectomy Patients

Abstract Aim After primary closure of a midline laparotomy wounds the estimated incisional hernia incidence can be as high as 25%. For many years large bite closure has been the standard in mainstream surgical training. Evidence has emerged to suggest small bite closure may be superior. We looked to examine the incidence of incisional hernias for elective oesophagectomies in one centre where both small bite and large bite techniques are performed. Method A retrospective analysis of 117 patients was performed. Follow up was for a maximum of five years and involved a combination of radiological and clinical reviews. Primary outcomes were defined as incisional hernia rates &amp; wound infections. Patient risk factors were recorded including age, co-morbidities such as cardiovascular or renal disease, diabetes, smoking, weight, steroid use and post-op complications. Results 74 patients had big bite closures and 38 had small bite closures. Overall there were 6 incisional hernias, 3 in each group (7.8% vs 4%, p-value 0.2). There were higher rates of wound infection in the small bite groups but again this failed to reach significance (7.9% vs 2.7% p-value 0.11). Conclusions Overall both outcomes are lower than the national averages which may explain the difficulty reaching significance. However, the results do suggest there may be other factors involved contributing to outcomes between small bite and big bite closure including operator familiarity.

The impact of colon injuries on the outcome of gunshot wounds to the abdomen

PurposeFactors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients’ overall outcomes.MethodsThis cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021.ResultsOf 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046).ConclusionGunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication.

SP1.8 Comparing the efficacy of povidone-iodine versus normal saline in laparotomy wound irrigation to prevent surgical site infections: A meta-analysis

Abstract Objective Surgical site infections (SSIs) are associated with increased mortality, morbidity and cost to provide healthcare in patients undergoing laparotomy and abdominal surgery. The objective of this study is to evaluate the role of laparotomy wound irrigation either by povidone-iodine (PVI) or normal saline (NS) in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce SSIs. Materials and methods Randomized controlled trials (RCTs) reporting the role of laparotomy wound irrigation with PVI versus NS in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce the risk of SSIs were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 13 RCTs on 3816 patients undergoing laparotomy for various gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations prior to the laparotomy skin wound closure. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk [odds ratio 0.54, 95%, CI (0.30, 0.98), Z = 2.04, P=0.04] of SSIs. However, there was significant heterogeneity (Tau2 = 70; Chi2 = 40.19, df = 12; (P = 0.0001; I2 = 70 %) among included studies. Conclusion Laparotomy wound irrigation with PVI has shown clinically proven advantage of reducing the risk of SSIs.

320 Surgical Site Infections (SSIs)- Are you doing your part to prevent them?

Abstract Aims (1) To evaluate the current literature regarding prevention of surgical site infections (SSIs). (2) To assess our General Surgery department SSI rate. (3) To implement changes within the department that are reflective of current evidence/guidance. (4) To re-audit our SSI rate post implementation of changes. Methods Evaluated and summarised 3 studies published in 2022 relating to the use of surgical care bundles to reduce SSIs. Collected post- operative laparotomy data within 2022; primary outcome SSI prior to discharge. Secondary outcomes: organism grown on wound culture, prolongation of hospital stay and other hospital acquired infections. Trust data and literature review presented a local department meeting. Consultant Surgeon cohort concluded which changes were to be implemented (pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy). Post-operative laparotomy wound data recollected after changes. Results Clear literature evidence in support of surgical care bundles. Pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy all found to contribute to a statistically significant reduction in SSIs. Implementation of these changes led to a reduction of SSIs within the department. Conclusions SSIs are the most common surgical complication worldwide. They lead to increase morbidity/mortality, prolonged hospital stays and increase economic burden. Recent literature has highlighted simple measures to reduce SSIs. Implementation of these measures has led to a department wide reduction in SSIs.

Prevention of complications from the laparotomy wound in abdominal gunshot injury

The OBJECTIVE was to evaluate the effectiveness of the original technique for assessing the reparative potential of the anterior abdominal wall in the prevention of complications from the laparotomic wound in abdominal gunshot injury.METHODS AND MATERIALS. The comparative assessment of the results of surgical treatment of 145 victims with abdominal gunshot injury, which were divided into 2 groups, was made. The retrospective group included 92 patients who underwent a standard approach to the prevention of infectious complications in the surgical area: perioperative administration of antibiotics, daily dressings, as well as laboratory monitoring of acute phase parameters and instrumental assessment of tissue condition (ultrasound). The prospective group was formed from 53 patients in whom, as part of the prevention of the infectious process, the original method for assessing the reparative potential of the tissues of the anterior abdominal wall was used (priority certificate for the invention ¹ 2023109198 dated 04/12/2023). The studied groups were comparable in terms of the main clinical criteria: the age of the victims, the severity of injuries, and the structure of surgical interventions.RESULTS. Suppuration of the laparotomic wound was noted in 22 patients in the retrospective group and in 4 in the prospective group, which accounted for 23.9 % and 7.5 % of their number (p=0.014). Eventration was observed in 11 patients in the retrospective group and in one patient in the prospective group (11.9 % and 1.9 %, p=0.05).CONCLUSION. The use of the original technique for assessing the reparative potential of the tissues of the anterior abdominal wall makes it possible to reduce the incidence of complications from the laparotomic wound in abdominal gunshot injury.

COMPARING THE EFFICACY OF MODIFIED CONTINUOUSSMEAD-JONES VERSUS CONVENTIONAL CLOSURE OFMIDLINE LAPAROTOMYWOUND

Background: Disruption of abdominal incision is a serious event. Variousmethods have been employed in abdominal surgeries to close theabdominal wall.Abdominal wound dehiscence is a common complication of emergency laparotomy. Thereis an increase in the cost and hospitalstays. Prevention of this complication is important inreducingpost-operativemorbidity and mortality. Objectives: ThestudywascarriedoutintheDepartmentofGeneralSurgery,MMC&amp;RI,Mysuru. 1. ToevaluateeffectivenessofmodifiedcontinuousSmead-JonesTechnique. 2. To compare effectiveness of modified continuous Smead-Jones withconventionaltechniqueofabdomenwoundclosureonthebasisofincidenceofwounddehiscence. Methods: The study was carried out on a total of 110 patients who were randomized intwo groups of 55 each. 55 patients underwent closure of mid line laparotomywound using modified continuous Smead-Jones technique(study group)and 55 patients underwent closure by conventionalmethod(control group). Results: The mean age group was 46 to 49. Male patients were more common comparedtofemale.Outofthevariouscausesofacuteabdomen,Prepyloricperforationwasthemostcommoncause,followedbyduodenalperforation.Outof 11 cases who had wound dehiscence,mostofthemwere for Pre pyloric perforation(55%), second most common was ileal perforation(27%). Patientswith risk factors had higher incidence of wound infection and wound dehiscence. Outof 110 patients, 32(29.1%) had wound infection, 12(21.8%) in the study group and20(36.3%) inthecontrolgroup.A total of 11(10%) patients had wound dehiscence, only 2 (3.6%) patients in the studygroup, whereas 9 (16.3%) in thecontrol group. Interpretationandconclusion:ModifiedSmead-Jonestechniquedecreasestheincidenceofwounddehiscenceand can be used to close the midline laparotomy wound in cases requiring emergencymidlinelaparotomy.

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.

A PROSPECTIVE STUDY OF FACTORS AFFECTING POST LAPAROTOMY ABDOMINAL WOUND DEHISCENCE

Background: Break in continuity of the skin with or without deeper tissues, following laparotomy, results in abdominal wound dehiscence. This study was done to evaluate the risk factors that lead to wound dehiscence in the postoperative period. Aim- this study was conducted to analyze various factors which are responsible for post-laparotomy wound dehiscence. Material and Methods: This was a prospective study done on 120 patients who developed wound dehiscence following laparotomy. The pre-operative investigations, intraoperative ndings, and any postoperative complications were recorded in a specied Performa. Results: The highest incidence of wound dehiscence was found to be in patients of the second to a fourth decade, with male preponderance. patients were found to be malnourished cachexia (BMI&lt;22) and 99 patients were anemic. 86 (71.67)had low serum albumin, 16% had raised serum bilirubin and 4 patients were diabetics. Decreased renal function was found in 87 (72.5) patients.. In 54 (45%) of patients, laparotomy wounds were either contaminated or dirty. Post-operative nausea and vomiting were found in patients. Conclusions : Abdominal wound dehiscence after laparotomy is a surgical emergency with high morbidity and mortality leading to an escalation in hospital costs and prolonged illness. This complication can be avoided if the factors involved in wound dehiscence are properly addressed.

Effect of anti-adhesion agents on cytokine profile in an experimental model of postoperative intra-abdominal adhesions

Many attempts have been made to prevent peritoneal adhesions using anti-adhesion agents, barriers and other therapeutic approaches, but their efficacy has not been widely accepted. Purpose – to determine the effects of mezogel, a mixture of metronidazole, dextran, and contrykal enriched with oxygen based on the pro- and anti-inflammatory cytokine concentration in rats with simulated postoperative peritoneal adhesions. Materials and methods. A total of 90 outbred white rats, divided into three groups of 30 animals each, underwent laparotomy and mechanical injury of the small bowel wall until a drop of blood appeared. After mechanical injury of the small bowel wall, the abdominal wound in group 1 animals (control) was closed with a layered suture technique; group 2 animals (comparison) were administered one mL of mezogel into the abdominal cavity before layer-by-layer suturing; group 3 animals (experimental) were introduced one mL of a specially prepared mixture of metronidazole, dextran, and contrykal (in a ratio of 1:1:0.1, respectively) enriched with oxygen into the abdominal cavity before the laparotomy wound was closed. Each surgical intervention lasted 15–20 minutes. On days 5, 10 and 21 of the experiment interleukin (IL) 4, IL-6, IL-10 and tumour necrosis factor alpha (TNF-α) were determined in the blood by enzyme immunoassay using corresponding test kits manufactured by Bender Medsystems (Austria). Results. The levels of the anti-inflammatory cytokines IL-4 and IL-10 increased dynamically in groups 2 and 3, while group 1 showed their decrease. The proinflammatory cytokine IL-6 and TNF-α concentration decreased in the experimental and comparison groups during the study period. On day 5 in groups 2 and 3, compared to group 1, the IL-6 concentration was reduced by 28.4% (p=0.029) and 41.0% (p=0.006), respectively. Group 3 animals had a 17.6% (p=0.043) lower IL-6 level compared to group 2 animals. On days 10 and 21 a dynamic decrease in IL-6 was observed in the animals of groups 2 and 3. Group 3 animals had the lowest TNF-α, 41.9 % (p=0.001) lower than in group 1, and 31.7 % (p=0.118) lower than in group 2. There were significant strong relationships detected between IL-10 and IL-6 in all groups on day 5 of the study. Conclusions. The administration of anti-adhesion agents, mezogel and an oxygen-enriched mixture of metronidazole, dextran, and contrykal, inhibits inflammation, which is expressed as a decrease in the concentrations of IL-6 and TNF-α. These agents lead to a negative interaction of anti-inflammatory cytokines with pro-inflammatory cytokines, in particular IL-4 with IL-6 and IL-10 with IL-6, indicating a greater prophylactic effect. The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines. No conflict of interests was declared by the authors.

Left Trans-thoracic Evisceration of a Perforated Transverse Colon

We received a 31 years old male who presented to the emergency after been stabbed on both thorax. The left thoracic wound was the site of evisceration of colon. The eviscerated colon was perforated. The patient was instable. After stabilisation, he was operated under general anesthesia. A bilateral thoracic drainage done,one and the right thoracic stab wound was then closed. A median laparotomy discovered the left colic herniation through the left diaphragmatic coupole, continuing through the thorax by the evisceration and a gastric tear. The colon was wached and reduced first through the abdomen by gentle traction. The left parietal wound was then closed. The left thorax cavity was washed and the diaphragmatic hole closed. The left transverse colonic tear was excised and closed. He stayed 5 days in the intensive care unit. We had a superficial site infection of the laparotomy wound treated by saline wet dressing for 20 days. After one month hospitalisation, the patient was discharged. He resumed his work after 3 months and is doing well at 12 months postoperative. This case emphasizes on a rare surprise awaiting the trauma surgeon.

Distinctive characteristics of granulation tissue in laparotomy wounds with underlying oncological processes.

This study aimed to investigate the effects of malignant neoplasms on the morphological characteristics of laparotomy wound granulation tissue in the muscular-aponeurotic layer. The study involved a sample of 34 deceased individuals who had undergone abdominal organ surgery. Biopsy samples were taken from the muscular-aponeurotic layer of the anterior abdominal wall and subjected to histological examination, including staining with hematoxylin and eosin and methylene blue/Chromotrope 2B using N.Z. Slinchenko's method. Descriptive methods and morphometry were used to evaluate pathomorphological changes. The results suggest that malignant neoplasms significantly impede and decelerate the maturation of laparotomy wound granulation tissue. Surgeries performed at the late stages of abdominal organ malignant neoplasms result in an uneven and slow maturation of the tissue, characterized by a higher prevalence of lymphoid cells, increased blood vessel volume, reduced optical density of stained collagen fibers, and pronounced chromotropophilia of collagen fibers. These distinct features should be considered to prevent postoperative eventration, a complication that is more likely to occur in this patient group. Clinicians should be aware of the possible consequences of malignant neoplasms on laparotomy wound granulation tissue, which may require additional measures to prevent postoperative complications in these patients.

Microbial profile from peritoneal fluid and surgical wounds in patients with perforation peritonitis - A cross-sectional study from New Delhi.

Surgical site infection (SSI) remains one of the most common complications of perforation peritonitis, contributing not only to morbidity but also mortality. We studied the culture and sensitivity of intra-peritoneal fluid and post-operative laparotomy wounds, and found consistency in pathogen and sensitivity between the intra and post-operative samples in 25 cases (80.6%). Therefore, routine culture and sensitivity of peritoneal fluid and subsequently switching the empirical anti-microbial therapy accordingly is justified.

MORPHOLOGICAL PECULIARITIES OF THE SKIN GRANULATION TISSUE IN PATIENTS WITH MALIGNANT NEOPLASMS OF THE ABDOMINAL ORGANS.

The aim: To examine morphological peculiarities of the skin granulation tissue from the laparotomy wound in patients with malignant neoplasms of the abdominal organs. Materials and methods: 36 bodies of deceased people were examined after midline laparotomy performed for surgical treatment of diseases of the abdominal organs. The main group included 22 bodies of deceased people suffering from malignant neoplasms of the abdominal organs, mostly in ІІІ-IV stages of diseases. The group of comparison included 14 bodies of deceased individuals suffering from acute surgical diseases of the abdominal organs. An average length of the laparotomy wound was 24,5 ± 0,28 cm. An average distance from the reticular elements to the external border of the granulation tissue was measured by means of computed histometry (mcm), the optical density (OD) of staining of the collagen fibers was determined by means of computed microdencitometry (expressed in OD absorbance coefficient - the absorbance of the solution per unit length per mole of solute), the specific volume of the blood vessels in the granulation tissue - by means of computed histostereometry (%), the granulation tissue cells were calculated by means of the score test (within eyeshot 10000 mcm2). The specimens were stained with hematoxylin, eosin and methylene blue/Chromotrop 2B. Results: The obtained results of the investigation conducted are indicative of more prominent chromotropic properties in the samples of the main group, confirming certain biochemical changes and features of the collagen fibers respectively. Moreover, slide mounts of the main group possess reliably lower optic density of staining of the collagen fibers which is indicative of their slow formation. It may suggest a reduced solidity of the postoperative scar on the laparotomy wound skin promoting easier wound disruption, that is, occurrence of subcutaneous eventration in patients with malignant neoplasms of the abdominal organs. Conclusions: Oncological process in the body results in the aggravation of swelling and chromotropophilia in the deep layers of derma during more remote terms after surgery and reduced optic density of the collagen fibers staining, which promotes easier laparotomy wound disruption and occurrence of true postoperative eventration.

“A COMPARATIVE STUDY OF SINGLE LAYER CLOSURE AND CONVENTIONAL LAYERED CLOSURE OF LAPROTOMY WOUNDS IN OUR INSTITUTE.”

Background: Many of the operations performed by the general surgeons take place within the abdomen and consequently incision and suturing of the abdominal layers are the commonest exercises in operative surgery. Abdominal closure is very important as regards to incision, technique of repair and use of newer suture material, and has created a great interest to surgeons. Recent data suggests that technical factors are crucial and can be manipulated by the surgeon. Different suture techniques are used for closure of laparotomy wounds and each has its strong proponents. But the ideal method of abdominal wound closure is modied frequently. Commonly followed methods of abdominal closure are conventional layered closure and single layer closure. Since 1973, different workers have carried out comparative studies of these two methods with encouraging results and single layer closure was found to have denite advantages over conventional closure as regards to operating time, cost, feasibility, ease and postoperative morbidity. The present study is taken up to evaluate the advantages of single layer closure in comparison with the conventional layered closure on the basis of operative time, healing time and postoperative morbidity such as wound infection, burst abdomen and incisional hernia. To compare the techniques of single layer closure and conve Objective: ntional layered closure of laparotomy wounds on the basis of operative time and post- operative complications. Prospective study of 100 patients who un Methods: derwent laparotomy in CU Shah Medical College and Hospital, Surendranagar, for abdominal surgical problems needing either emergency or elective surgery was carried out after taking approval from ethical committee. Out of these 100 patients, 50 patients underwent laparotomy wound closure by single layer closure technique and the rest 50 patients by conventional layered closure technique. Time taken for closure of laparotomy wound was noted and patients were followed up post-operatively for any wound complications like seroma, wound infection, wound gaping, burst abdomen and incisional hernia. The mean time taken for closure of laparotomy wounds by single layer closure technique was 19 Results: minutes and by conventional layered closure technique was 27 minutes. There was a difference of 8 minutes which was statistically signicant (p=0.001). In the postoperative period, in patients who underwent single layer closure, totally 9 patients (18%) had post operative complications. In those 3 patients (6%) had seroma, 3 patients (6%) had wound infection, 2 patients (4%) had wound gaping, 1 patient (2%) had burst abdomen and none had incisional hernia. In patients who underwent conventional layered closure, totally 15 patients (30%) had post operative complications. In those 5 patients (10%) had seroma, 4 patients (8%) had wound infection, 3 patients (6%) had wound gaping, 2 patients (4%) had burst abdomen and 1 patient (2%) had incisional hernia. Laparotomy wound closure with single layer closure technique i Conclusion: s better than the conventional layered closure technique in terms of decreased operative time and also decreased postoperative complication

Comparison between Interrupted X Suture and Continuous Suture for Closure of Midline Incision in Emergency Laparotomy : A Randomized Controlled Trial

Background: Wound dehiscence is disruption of any or all of the layers in a wound. At around 7–10 days post operatively leakage of clear sero-sanguinous fluid from the wound is usually the first indicator of burst abdomen. The patient usually feels something ‘giving away’ at this time.It may occur in 3-14.5% cases and is very distressing to the patient.Number of methods of closure of midline laparotomy wound have been introduced in the past to prevent this outcome. The study to compare the result of continuous and interrupted closure of midline emergency laparotomy in respect of burst abdomen.&#x0D; Materials and methods: This randomized controlled trial study was carried out in the Department of Surgery Chittagong Medical College Hospital, Chattogram, duration January 2017 to December 2017. A total of 500 patients were enrolled in this study. Data were collected, statistical analyses were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-23).&#x0D; Results: 250 patients in group A and 250 in B. Surgical wound related post-operative complications were found in 30.4% of the study subjects (n=152).Wound dehiscence was found in 11% subjects, surgical site infection was found in 18.4% subjects and incisional hernia in 1%.All these complications were significantly higher in continuous suture group than interrupted group (p&lt;0.001).Wound dehiscence in 20 subjects, treated with interrupted sutures and in 40 subjects (35 wound dehiscence and 5 incisional hernia)treated with continuous suture. The Relative Risk (RR) of developing wound dehiscence post-operatively was found to be 0.63 (95% CI 0.33 – 0.72) for interrupted suture. This was statistically significant (p&lt;0.05).&#x0D; Conclusion: The interrupted X suture technique is better than continuous suture technique in prevention of burst abdomen in emergency midline laparotomy.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 52-56

Chronic urinary tract infection by biofilm-producing Mycobacterium abscessus following a posttraumatic laparotomy wound infection

Mycobacterium abscessus is an emerging hospital-acquired infection, mostly found after surgical procedures and instrumentations, but urinary isolate of M. abscessus is rarely reported. Here we present a case of an immunocompetent individual where M.abscessus was isolated from a post laparotomy wound on the abdomen which recovered after treatment both clinically and microbiologically. Subsequently, M.abscessus was also isolated from urine when the patient presented with chronic cystitis, not responding to conventional antibiotics. Further management was planned to be done in the light of biofilm. Further management was planned to be done in the light of biofilm.