Laparotomy Wound Research Articles

A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

ОПРЕДЕЛЕНИЕ КОНЦЕНТРАЦИИ РОПИВАКАИНА В ВЕНОЗНОЙ КРОВИ ПРИ ПРОВЕДЕНИИ ДЛИТЕЛЬНОЙ АНАЛЬГЕЗИИ ПОСЛЕОПЕРАЦИОННОЙ РАНЫ

Aim. Determinations of concentrations of total ropivacaine in venous blood with use of the selected scheme of prolonged analgesia of the postoperative wound after cesarean operation. Materials and Methods. The study involved 47 female patients after cesarean operation in whom during suturing of the laparotomy wound a multiperforated catheter was installed under aponeurosis of the abdominal muscles for a prolonged postoperative analgesia. With use of infu-sion pump, 0.2% ropivacaine solution was introduced at constant speed 4 ml/h with the total amount 200.0 ml. Blood was taken by puncture of the peripheral vein in control points in 30 min, 24 hours and 48 hours after the start of injection of the solution. The quantitative determination of the concentration of the total ropivacaine of venous blood plasma (free and bound with plasma proteins) was conducted using gas chromatograph with mass-selective detector. Results. The highest concentrations of the total ropivacaine of venous blood were recorded in 48 hours Me (Q1; Q3)=0.053 (0.043; 0.071) which was significantly lower than minimal potentially toxic concentrations. Also not a single case of appearance of clinical signs of systemic toxicity of local anesthetics was recorded. No statistically reliable correlation was found between body mass, height, body mass index and concentration of total ropivacaine in blood. Conclusion. The given study permitted to confirm safety of the selected scheme of introduction of the solution of local anesthetic, since no potentially toxic concentrations of the total ropivacaine were reached in venous blood in a single patient included into the study.

Effect of intra-abdominal hypertension on the strength of the postoperative scar of a laparotomic wound

Annotation. One of the main factors of postoperative eventration is intra-abdominal hypertension, which occurs in various surgical pathologies of the abdominal cavity. Despite the presence of a large number of scientific papers on the negative effect of intra-abdominal hypertension on the morphological state of granulation tissue in the area of the laparotomy wound, there are no publications on the impact on the strength of the postoperative scar. Therefore, the study aimed to investigate in an experiment on small laboratory animals the effect of intra-abdominal hypertension on the mechanical strength of the postoperative scar of a laparotomy wound. The experiment was performed on 120 laboratory rats, which underwent a median laparotomy and brought together the edges of the musculoaponeurotic layer of the anterior abdominal wall with simple nodal sutures. The main group consisted of 72 animals who developed intra-abdominal hypertension by inserting a container (condom) with a certain amount of Furacilin into the abdominal cavity. The comparison group consisted of 48 animals who had an empty condom inserted into the abdominal cavity after laparotomy. The mechanical strength of the postoperative scar of the laparotomy wound was determined by the method of G. V. Petrovich (2010) on the 1st, 3rd, and 5th day after the creation of intra-abdominal hypertension, by measuring the level of intra-abdominal pressure at the time of rupture of the postoperative scar of the laparotomy wound. Statistical analysis of the results was performed using Microsoft Excel spreadsheets and a package of statistical processing software PAST. Differences between study groups were determined using Mann-Whitney criteria. The results of the study indicate that the created intra-abdominal hypertension leads to a decrease in the mechanical strength of the postoperative scar of the laparotomy wound. The degree of the negative impact of intra-abdominal hypertension on the strength of the postoperative scar is inversely proportional to the level of intra-abdominal pressure.

Surgical management of ileocolic intussusception in a German shepherd dog

Intussusception occurs when excessive peristaltic motility forces one segment of the intestine into another slightly larger part of the intestine. The incidence of intussusception is more in German shepherd dogs. A six-month old German shepherd dog weighing 17 kg was presented with a history of anorexia, vomiting, diarrhoea, and lethargy for the past 7 days. Clinical examination revealed a congested conjunctival mucous membrane, bounding pulse and tachycardia. Abdominal palpation evinced pain and a bunch of coiled sausage shaped mass was identified during deep palpation. Abdominal ultrasonography revealed bulls eye appearance in the intestine confirming the occurrence of intussusception. Pre-operatively, the animal was hydrated and stabilized with intravenous fluids. Prophylactic antibiotic therapy using ceftriaxone was given at a dose rate of 25 mg per kg bodyweight and pre-emptive analgesia with meloxicam at a dose rate of 0.2 mg per kg bodyweight was also given. Emergency laparotomy was performed under general anaesthesia maintained with isoflurane. A 20 cm long necrosed irreducible intestinal segment was identified. The necrosed loop was resected after ligating the mesenteric vessels. The cut ends of the intestine being uneven, was cut at right angles and the smaller segment was further cut at an oblique angle to correct the disparity in the lumen size. End to end anastomosis was performed using polydioxanone suture in a simple continues pattern. The abdominal cavity was lavaged with normal saline. Laparotomy wound was closed in a routine pattern. Post operatively, the dog was treated using fluids, antibiotics, and analgesics for seven days. The owner was advised to give easily digestible liquid diet in small quantities from fourth day onwards and gradually shift to normal food. The skin sutures were removed on 10th post-operative day and the animal made an uneventful recovery. Keywords: Ultrasonography, Intestinal telescoping, Resection, Anastomosis, Surgical management, Deworming

Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

The use of intestinal exteriorization technology in the treatment of congenital diaphragmatic hernia in a newborn infant

The result of the surgical treatment of a newborn infant with congenital diaphragmatic hernia complicated by pulmonary hypertension and ischemic lesion of the small intestine is presented. Using the technology of intestinal exteriorization after conversion of thoracoscopic access to laparotomy, plastic surgery of the left dome of the diaphragm, and moving the changed loops of the small intestine into a silo sewn to the edges of the laparotomy wound allowed avoiding serious complications in the postoperative period. 7 days after the first operation, bowel loops were immersed in the abdominal cavity, and suturing of the laparotomy wound was performed. During the follow-up examination for 2 years after the operation, the diaphragm is usually located, there are no signs of impaired bowel function.

A prospective study of assessment of prognostic factors in early and late wound dehiscence in midline vertical incision

Background: Wound dehiscence is separation of some or all layers of incision. It may be partial or complete. It is called as complete when all layers of the abdominal wall have been separated with or without evisceration of viscous. The study aims to find out and record the prognostic factors for wound dehiscence in vertical midline laparotomy.Methods: This was a prospective study in 1400 laparotomies that developed wound dehiscence operated in Gandhi Medical College, Bhopal from august 2017 to august 2019. All the patients with burst abdomen operated during emergency or elective setting by midline vertical laparotomy were included.Results: Wound dehiscence was most common in 51-60 years age group (26%). Majority patients were males (62%). Emergency laparotomy showed maximum incidence (71%). Bursts were seen mostly during 6th to 10th postoperative day. 78% patients presented as partial wound dehiscence and remaining as complete wound dehiscence. 46% presented as early wound dehiscence (7 days).Conclusions: Post laparotomy wound dehiscence has multifactor etiology. Respiratory infections, anemia, and hypoproteinaemia are the contributing factors. Improper haemostasis during surgery and poor surgical technique are the predisposing factors.

The Selective Angiotensin II Type 2 Receptor Agonist Compound 21 Reduces Abdominal Adhesions in Mice

BackgroundAbdominal adhesions (AAs) are post-traumatic fibrous bands that connect visceral and/or peritoneal surfaces, leading to possible long-term complications. The effect of a novel antifibrotic selective angiotensin II type 2 receptor agonist, compound 21 (C21) on AA formation was assessed in a murine model. MethodsFemale BALB/c mice were laparotomized and the cecum and overlying parietal peritoneum abraded. C21 (10 μg/kg) or saline (vehicle) were administered orally or intraperitoneally daily. Mice were sacrificed 8 days after surgery, adhesions graded, and peritoneal fluid collected for transforming growth factor (TGF)-β levels. Laparotomy incisions were excised for immunohistochemistry. In vitro, scratch assays were performed using primary parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21 (10 μM), angiotensin II (1 μM), or both. Western blot analysis of primary cell lysates was performed for total and phosphorylated SMAD 2/3. ResultsOral and intraperitoneal C21 reduced AA formation and TGF-β levels in peritoneal fluid. Surgical incisions demonstrated decreased α-smooth muscle actin expression in C21-treated animals, but no difference in vascularity, macrophage infiltration, collagen I/III distribution and density, and dermal thickness. Migration and expression of phosphorylated SMAD 2/3 was reduced in parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21. ConclusionsLocal and systemic C21 administration reduced or completely prevented AA formation. These findings may be attributed to decreased intraperitoneal TGF-β in vivo and decreased migration of peritoneal fibroblasts and visceral mesothelial cells. Importantly, C21 did not have histologically quantifiable effects on laparotomy wounds, suggesting C21 could reduce AA formation without compromising laparotomy healing.

Differentiated treatment tactics in surgery of liver echinococcosis

Purpose of the study. Improving the quality of treatment for liver echinococcosis by improving surgical tactics and developing eff ective methods to reduce disease recurrence. Materials and methods: 371 patients with echinococcosis of the liver, who were admitted to the surgery department of the 2nd clinic of Samarkand State Medical Institute, were examined. Of the 371 patients in 311 (83.8%) patients, the disease was detected for the fi rst time and in 60 (16.2%) patients, echinococcosis was recurrent. The results of the study: compared with 2005–2008. the incidence of postoperative complications decreased from 13.1 to 4.3%. Complications such as suppuration of the residual cavity (6 times), suppuration of the laparotomy wound (2 times), the formation of bile fi stulas (3 times), and no subphrenic abscesses began to occur much less frequently. The duration of inpatient treatment after surgery decreased by 2 times compared with the control — from 21.2 ± 1.2 to 10.9 ± 0.3 days. Conclusions: the developed algorithm for choosing the tactics of surgical treatment of liver echinococcosis, taking into account the integrated approach to choosing access, the method of treatment and elimination of the residual cavity, as well as preventive chemotherapy, has improved the quality of care by reducing the frequency of immediate postoperative complications from 12.5% to 4, 3% (p = 0.027 according to the χ2 criterion) and relapse of the disease from 11.9% to 2.6% (p = 0.031 according to the χ2 criterion).

Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials.

Surgical site infections are a common source of post-operative morbidity and contribute significantly to healthcare costs. Patients undergoing emergency laparotomy and/or bowel surgery are particularly at risk. Prophylactic negative pressure wound therapy (NPWT) has been shown to reduce wound infection. However, to date, there has been a lack of consensus around its use for closed laparotomy wounds. We conducted a systematic review of randomised controlled trials comparing the use of prophylactic negative pressure wound therapy with standard dressings for closed laparotomy incisions. The primary outcome was incidence of incisional surgical site infection (SSI) at 30 days post-operatively. Secondary outcomes included superficial and deep SSI, skin dehiscence, fascial dehiscence and length of stay. A total of 2182 publications were identified, of which, following review of titles, abstracts and full texts, five studies met the criteria for inclusion. Across these studies, 467 patients were randomised to NPWT and 464 to standard dressings. Overall SSI rate was 18.6% (n = 87/467) versus 23.9% (n = 111/464) in the NPWT and standard dressing groups, respectively (Odds ratio 0.71, 95% CI 0.52–0.99, p = 0.04*). Deep SSI incidence was the same in both groups (2.6%). Both skin dehiscence and fascial dehiscence were slightly higher in the standard dressing group ((4.2%, n = 11/263 versus 3.1% (n = 8/261) and (0.9% (n = 3/324) versus 0.6% (n = 2/323)), respectively. This study observed that NPWT reduces the overall SSI for closed laparotomy wounds. It supports data recommending the use of prophylactic NPWT dressings, especially in high-risk patients in both emergency and elective circumstances.

Thuja occidentalis mediated AuNPs as wound dressing agents for abdominal wound healing in nursing care after surgery

Prevention of infection at the surgical area and outbreak of wounds are the most important and at the same time challenging tasks in clinical care. This research investigates the healing effect of laparotomy wounds after the use of bio-fabricated gold nanoparticles (Au NPs) prepared utilizing Thuja occidentalis leaf extract. Ultraviolet–visible (UV–Vis) spectroscopy and X-ray diffraction (X-RD) results confirmed the successful formation of Au NPs. High-resolution Transmission Electron Microscopy (HR-TEM) images confirmed the formation of spherical shaped Au NPs comprising of 30–50 nm particle size. Dermal fibroblasts were subjected to increased concentrations of Au NPs and their effect of cytotoxicity and synthesis of collagen was evaluated. The procedure of celiotomy was conducted on rabbits where the surgical area was exposed topically with either vehicle or once/everyday with Au NPs for about 14 days. Au NPs raised the collagen production from dermal fibroblasts and improved the expression of caspase 3 by exposure to a long period. AuNPs also showed cytotoxic impact with half-maximal inhibitory concentration (IC50) of 0.16 mg/mL. Regular treatment of surgical area with AuNPs led to higher collagen deposition with reduced microbial load and enhanced healing of wounds.

Negative Pressure Wound Therapy Compared to Petrolatum Gauze and a Bogota Bag to Manage Postoperative Midline Abdominal Wound Dehiscence: A Pilot, Nonrandomized Controlled Trial

A study was conducted to evaluate the efficacy of NPWT for fascial closure/cutaneous cover compared to non-NPWT treatment using petrolatum gauze and a Bogota bag in patients with postoperative laparotomy wound dehiscence. A single center, prospective, nonrandomized pilot study was conducted. Using convenience sampling methods, consecutive patients on 6 different surgical units who were at least 18 years of age and who developed postoperative abdominal wound dehiscence following elective and emergency laparotomy from January 2017 to December 2018 were recruited. NPWT dressing with polyvinyl white foam sponge or loosely packed, saline-soaked petrolatum gauze followed by Bogota bag application were used and compared. Baseline patient demographics and history were collected, and patients were followed for an average of 6 months after surgery. Number of days until first signs of granulation tissue appearance, time until complete granulation tissue cover/fascial surgical closure, and hospital discharge were compared. Categorical variables (gender, comorbidities, presence or absence of stoma, exposure to prior radiotherapy) were expressed as proportions and analyzed using chi-squared test or Fischer's exact test. Continuous variables such as age, body mass index, albumin, postoperative hospital stay, and number of days required for decision for fascial closure were expressed as Mean ± standard deviation and analyzed using an independent t test or Mann Whitney U test based on whether the data followed normal distribution. Postoperative day of wound dehiscence, the number of days for the appearance of granulation tissue, and the number of NPWT placements required also were assessed using Mean ± standard deviation and analyzed using an independent t test. A P value <.05 was considered significant. Sixty (60) patients were included, but 4 in NPWT group and 10 in the non-NPWT group could not complete the study, leaving 26 patients in NPWT group and 20 patients in non-NPWT group. Demographic and surgical variables were not significantly different. Patients in both groups achieved complete wound coverage by surgical closure or healing by secondary intention. Days until first signs of granulation tissue (2.92 vs. 6.65; P <.001), number of days until fascial closure (15.50 vs. 29.50; P <.001), and length of postoperative hospital stay (24.30 vs. 37.90; P <.001) were significantly less in NPWT group. Two (2) patients (7.6%) in the NPWT developed a fistula during the 6-month follow-up period. No fistulas developed in the control group, and no intra-abdominal abscesses, ventral hernias, or wound dehiscence were reported in either group. Time until first signs of granulation tissue appearance and complete granulation tissue coverage was significantly shorter in the NPWT group, but time until definitive closure was not evaluated. Randomized, controlled clinical studies to compare definitive time to wound closure and long-term follow up to evaluate long-term complication rates, including the risk of developing fistulas, are warranted.

Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports

Unstable pelvic ring fractures raise treatment challenges in severely injured patients. Beside patient survival, demanding surgical technique also required. Classic technique of internal fixation requires extensive surgical exposure that leads to most complications of the pelvic fractures fixation. Therefore less invasive technique is a reasonable alternative especially in unstable pelvic fracture with soft tissue injury or potential infection. Unfortunately in sacral dysmorphism pelvic injury or in complete vertical sacral fracture, we need S3 level insertion to improve stability of iliosacral (IS) screw in S1 or S2. Purpose of this study was to show feasibility technically inserting IS screw in S3 level.Methods:We reported 2 cases of unstable pelvic injury. First case was an 11 years old boy with Torode and Zieg IV or Marvin Tile C1 pelvic fracture with right sacroiliac joint disruption and soft tissue injuries of skin avulsion on the left hip and Morel-Lavallée lesion on the right hip. He was managed with early anatomic reduction and fixation with percutaneous screws on both pubic rami and IS screw (sacroiliac lag screw type) on S1 and S3. Second case was a 30 years old male with open pelvic fracture Faringer zone III type, Marvin Tile B2 or YoungBurgess LC I and also with vertical sacral fracture Denis zone 1. This polytrauma case had associated injuries includes Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence, and immunocompromised. The same minimal invasive management of pelvic fracture was performed in this case by inserting percutaneous screws on pubic rami and IS (sacral screw type) on S1 and S3. Functional outcome was evaluated using Majeed and Hannover pelvic scoring system.Results:All patients survived and considered to have good reduction, with no residual displacement on the sacroiliac joint. The former case, at 21-month follow up, present with excellent outcome (80 out of 80) by Majeed score and very good outcome (4 out of 4) by Hannover score; while the latter case, at 18-month follow up, present with poor outcome (50 out of 100) by Majeed score and fair outcome (2 out of 4) by Hannover score.Conclusion:Percutaneous screw fixation for pelvic ring injury is a less invasive alternative that can be used for early stabilization of unstable anterior and posterior pelvic fractures and provide stable internal fixation. IS screw is feasible to be inserted in S3 level either sacroiliac joint type or sacral screw type.

Laparotomy- and groin-associated complications are common after aortofemoral bypass and contribute to reintervention

BackgroundDespite endovascular advancements, aortofemoral bypass (AFB; aortounifemoral and aortobifemoral bypass) remains the most durable option for aortoiliac occlusive disease. Whereas AFB reduces vascular aortoiliac reintervention, the impact of laparotomy-associated and groin wound complications on morbidity and reintervention is unclear. The aim of this study was to establish the incidence of nonvascular complications after AFB and to determine their effect on reintervention. MethodsInstitutional data for AFB (2000-2017) were queried. Primary end points included laparotomy-associated and groin wound complications. Total reintervention was defined as the composite outcome of reinterventions for laparotomy and groin wound complications and graft patency. Kaplan-Meier analysis estimated freedom from reintervention. Fine-Gray method for competing long-term risk determined predictors of laparotomy complications. Logistic regression, adjusting variability for patient-level clustering, determined predictors of wound complications. ResultsThere were 553 limbs in 281 patients (272 aortobifemoral and 9 aortounifemoral bypasses; age, 67.6 ± 11.0 years; 50.5% female). Ninety (32%) patients had prior abdominal surgery, 3.2% had prior ventral hernia (VH) repair, 2.9% had untreated VH, and 0.7% had history of small bowel obstruction. The majority of patients underwent AFB for claudication (66.2%); 87.2% had TransAtlantic Inter-Society Consensus (TASC) D lesions, 31.4% required a suprarenal clamp or higher, 16.4% had concomitant renovisceral revascularization, and 6.4% were receiving anticoagulation. Sixty-seven (12.1%) limbs had redo femoral artery exposures, 32.4% required femoral outflow adjunct, and 1.8% had simultaneous lower extremity bypass. The 30-day mortality was 2.9%. During median follow-up of 5.3 years (interquartile range, 7.3 years), 21% had laparotomy complications (VH, 15.3%; small bowel obstruction, 7.5%; other, 2.1%), including 10.0% requiring operative intervention. Sixty-seven (12%) groins had a wound complication; 4.9% required intervention. Unadjusted 1-, 3-, and 5-year freedom from graft reintervention was 93.3% (95% confidence interval [CI], 90.1%-96.5%), 85.3% (80.7%-90.2%), and 79.6% (74.1%-85.5%), respectively. Freedom from total reintervention at 1 year, 3 years, and 5 years was 82.1% (95% CI, 77.4%-87.1%), 73.6% (68.0%-79.6%), and 65.1% (58.7%-72.2%). Predictors of laparotomy complications were untreated VH (P = .01) and hypertension (P = .01). Protective factors were thoracoabdominal approach (P < .01) and aortounifemoral bypass (P < .01). Predictors of wound complications included body mass index (per kg, 1.07; CI, 1.01-1.15; P = .018), anticoagulation (2.59; CI, 1.01-8.37; P = .049), and previous iliac stents (2.60; CI, 1.36-4.94; P = .004). ConclusionsWhereas AFB is a durable reconstruction with infrequent need for graft reintervention, laparotomy- and groin wound-associated complications contribute significantly to morbidity and reintervention after AFB. Predictive factors for laparotomy and groin wound complications should be considered in preoperative planning and selection of patients for AFB and in the discussion of outcomes.

Retrospective and prospective study of surgical site infection, associated risk factors and profile of causative micro-organisms in laparotomy wounds

Background: Surgical site infection (SSI), is a major complication of surgery and third most commonly reported nosocomial infection. SSI increase length of stays in hospital, costs of health care and morbidity and mortality of patients. This study aims to determine the incidence, associated risk factors and type of pathogenic organisms causing laparotomy wound infection. Methods: This study was done on 200 patients who underwent elective and emergency laparotomy. Diagnosis of wound infection was clinical. Discharge from all wounds was subjected to microbiological analysis.Results: The incidence of SSI following laparotomies is 25%. Risk factors being emergency laparotomy, dirty wound, male sex, increased age, smoking, diabetes mellitus, obesity, haemoglobin < 10 gm %, albumin < 3gm/dl, duration of surgery > 2hrs. Most common organism isolated was E. coli.Conclusion: In handling laparotomy cases all aseptic precautions should be maintained, risk factors should be identified early and infections should be treated as per culture sensitivity pattern.

Comparative Study between Mass Closure and Hughes Repair in Emergency Laparotomy

Abstract Background Exploratory laparotomy remains one of the common operations across the surgical disciplines. As such, the systematic and safe closure of such a laparotomy wound is the key to reduce the postoperative morbidity like wound pain, wound infection and incisional hernia. Objective To compare mass closure &amp; Hughes repair in emergency laparotomy as regard intraoperative technique, operation time, incidence of complication as wound infection, dehiscence, burst abdomen and incisional hernia. Patients and Methods This is a prospective comparative study between two types of closure, mass closure and hughes repair in emergency laparotomies. This study was conducted at Ain-Shams University Emergency Hospitals. Patients who underwent emergency laprotomy from September 2017 to March 2018 and the patients were followed up postoperatively for six months. All patients who underwent emergency laparotomy at Ain-Shams University Emergency Hospitals from September 2017 to March 2018 were chosen according to inclusion and exclusion criteria. Results In this study we used the same suture and materials” Polydioxanone PDS loop 1”. The comparative study included several items to discuss starting from the time of the technique in our study it ranged from 12 -19 minutes in the conventional method “Mass closure” and it ranged from 24-31 minutes in the huge repair group. It was observed that the length of the laprotomy incision determine the time of the technique. The overall operative time of mass closure group was shorter than the hughe repair technique Conclusion It was observed that there were major factors that affected the results such as the reason for the laparotomy and the general condition of the patient especially the chest condition, diabetes mellitus, serum albumin, anemia and the body mass index.

Abdominal wall closure with prophylactic mesh in colorectal operations.

Prospective studies demonstrate that over one-third of patients undergoing standard suture closure of laparotomy wounds will develop incisional hernias (IHs). Whilst prophylactic mesh has been demonstrated to decrease IH rates in clean laparotomy wounds, mesh has been associated with high rates of seroma formation (>30%), infection (>10%) and pain, discouraging many surgeons from using mesh, especially combined with intestinal surgery. The aim of this study is to review the experience of a single colorectal surgeon who, after noting high IH rates in his own patients, started placing prophylactic mesh routinely in patients judged to be at high risk of IH. The records of all patients undergoing bowel resections and ileostomy closure by one surgeon from 2008 to 2018 were independently retrospectively analysed. Of the 935 procedures identified, 662 patients underwent midline laparotomy with bowel resection and 273 patients underwent closure of loop ileostomy. Mesh was placed prophylactically in 221 (23.6%) of 935 procedures. Comparing the mesh and non-mesh groups, wound infections occurred in nine (4.1%) versus 23 (3.2%) (P = 0.53), seromas occurred in nine (4.1%) versus six (0.8%) (P = 0.003) and chronic pain was noted in 12 (5.4%) versus 17 (2.4%) (P = 0.04). The mean follow-up was 33 months in both the mesh and non-mesh groups. IHs have occurred in three (1.3%) of the mesh group compared to 95 (13.3%) of the non-mesh group procedures (P = 0.0001). In colorectal operations, prophylactic mesh decreases the risk of IH without prohibitive complications.

A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria

Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical site infection (SSI). We aimed to document the incidence, severity and management of wound complications when primary closure of abdominal wounds was performed following laparotomy for typhoid ileal perforation. Patients and Methods: This was a retrospective study of all patients who had primary abdominal wound closure following laparotomy for typhoid ileal perforation in Federal Medical Centre, Bida from January 2017 to December 2018. Results: There were 71 patients with the age ranges from 2 to 41 years and their median age was 15 years who had laparotomy for typhoid ileal perforation during the study period. All 71 patients had primary closure of their abdominal wounds, however two of them died within 72 hours of operation and were excluded from the study. There were males 38 (55.1%) and females 31 (44.9%) with a male to female ratio of 1.2:1. There was primary wound healing in 23 (33.3%) patients while 44 (63.8%) of them developed incisional surgical site infections (SSI) and 2 (2.9%) developed organ space SSI. Of the 44 patients that had incisional SSI, 33 (75.0%) were superficial and 11 (25.0%) were deep. Other complications noted from the study were faecal fistulae 3 (4.3%) and incisional hernia (4.3%). Conclusion: Though a high incidence of wound morbidity is not unexpected in situation of primary closure of laparotomy wound for bacteria peritonitis, an aggressive wound management may help to reduce the incidence and severity of wound complications in such situations.

Comparative study of efficacy of modified Smead-Jones technique versus conventional closure of midline laparotomy wound

Introduction: One of the most commonly used assess route for laparotomy is midline incision. But midline laparotomy incision also has major drawback such as increased incidence of postoperative wound dehiscence and incisional hernia. Methodology: In our study we compared two different types of mass abdominal closure technique and measured the primary outcome by measuring the incidence of wound dehiscence. Result: Out of 90 patients included in the study, the most common cause for midline laparotomy were duodenal perforation and ileal perforation, followed by pre-pyloric perforation. Out of 45 cases in control group, 6 cases (13.3%) and in study group 1 case (2.2%) had incidence of wound dehiscence. Conclusion: Modified Smead-Jones technique decreases the incidence of wound dehiscence and thus concludes that this technique has low incidence of wound dehiscence as compared to conventional technique and might also decrease the incidence of incisional hernia.

A study of the factors affecting post laparotomy wound healing

A study of the factors affecting post laparotomy wound healing