Laparotomy Research Articles

Pulmonary valve replacement via ministernotomy, early experience

The population of patients requiring pulmonary valve replacement (PVR) following surgery of the right ventricular outflow tract during infancy is growing. Full conventional sternotomy is widely used for PVR, while left anterior minithoracotomy has been described only in selected cases. Our aim is to describe our early experience with upper left ministernotomy as a systematic approach for PVR in teenagers and adult patients. From December 2019 to December 2021, 13 consecutive patients underwent PVR via ministernotomy at our institution. The indications were severe pulmonary regurgitation in 11 patients and severe conduit stenosis in 2 patients. Ten patients (76.9%) already had at least 1 sternotomy. Pulmonary homografts, stentless porcine bioprostheses or stented pericardial bioprostheses were implanted. Age at operation was 24.6 years old (17.6–38.4). There were no deaths, no cardiac injuries and no conversions to full sternotomy. The 3rd intercostal space was the most frequently used for the leftward extension of the ministernotomy ( Fig. 1 ). In 6 patients (46.1%), a residual intracardiac shunt was present and aortic cross-clamping was necessary. Median cardiopulmonary bypass and cross-clamping times were 70 (64–105.5) and 50 (40–75) minutes, respectively. Median intensive care and hospital stays were 2 (1–2.5) and 7 (6–11) days, respectively. All patients are doing well after a median follow-up of 16.2 months (13.5–19.0). Ministernotomy is a safe approach for PVR and redo PVR in teenagers and adults. This approach combines the advantages of minimally invasive surgery (expedited recovery) and those of a midline incision such as the access to the ascending aorta and the absence of additional scar in cases of redo PVR.

Operative Findings and Outcome of Abdominal Wound Dehiscence in Emergency Laparotomy

Introduction: Dehiscence is the partial or complete separation of previously approximated wound margins as a result of inadequate wound healing. Wound dehiscence is most common following an open wound surgery. It's also known as wound breakdown, wound disruption, or wound separation. Various preoperative and postoperative variables might impact it, and these factors can also influence the patient's result following surgery. Aim of the Study: The aim of the study was to observe the operative findings and outcome of patients with abdominal wound dehiscence that had undergone emergency laparotomy. Methods: This prospective clinical study was conducted at the Department of Surgery, MAG Osmani Medical College, Sylhet, Bangladesh. The study duration was 8 months, from July 2008 to February 2009. A total of 460 participants were selected from those undergoing emergency laparotomy in the study place for this study. A consecutive selection method was followed for the selection of the participants. The participants were divided into two groups depending on whether wound dehiscence was developed or not. Result: All the baseline characteristics (age, body mass index, and smoking habit) of patients except sex were significantly associated with wound dehiscence. The history of receiving steroid and cytotoxic drug were higher in patients with wound dehiscence than that in patients without wound dehiscence. However, the history of receiving the immunosuppressive drug was almost identical between the groups. The patients who did not take hygienic measures or take bath before an operation or change clothing had a higher incidence of wound dehiscence. The mean duration of operation, prolene suture used for closure, midline incision, mass closure technique and drain given had significant influence on development of wound dehiscence. Presence of ascitic fluid, pus and contaminated faecal material demonstrated their significant presence in patients who develop wound dehiscence than .....

Risk Factors and Operative Findings of Abdominal Wound Dehiscence in Emergency Laparotomy

Introduction: Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. Wound dehiscence primarily occurs after a surgery relating to an open wound. It is sometimes called wound breakdown, wound disruption, or wound separation. It can be influenced by various preoperative and postoperative factors. Various preoperative and postoperative variables might impact it, and these factors can also influence the patient's result following surgery. Aim of the Study: The aim of the study was to observe the risk factors and operative findings of abdominal wound dehiscence cases in emergency laparotomy. Methods: This prospective clinical study was conducted at the Department of Surgery, MAG Osmani Medical College, Sylhet, Bangladesh. The study duration was 8 months, from July 2008 to February 2009. A total of 460 participants were selected from those undergoing emergency laparotomy in the study place for this study. A consecutive selection method was followed for the selection of the participants. The participants were divided into two groups depending on whether wound dehiscence was developed or not. Result: All the baseline characteristics (age, body mass index, and smoking habit) of patients except sex were significantly associated with wound dehiscence. The history of receiving steroid and cytotoxic drug were higher in patients with wound dehiscence than that in patients without wound dehiscence. However, the history of receiving the immunosuppressive drug was almost identical between the groups. The patients who did not take hygienic measures or take bath before an operation or change clothing had a higher incidence of wound dehiscence. The risk factors tuberculosis, diabetes mellitus, jaundice, bronchial asthma, anemia, edema, and dehydration were found significantly higher in wound dehiscent patients compared to those without wound dehiscence. The mean duration of operation, prolene suture used for closure, midline incision, mass closure technique and drain given had significant influence on development of wound dehiscence. presence of ascitic fluid, pus and contaminated fecal material demonstrated their significant presence in patients who develop wound dehiscence than those who did not develop wound dehiscence. Postoperative conditions like abdominal distention, coughing and wound infection tend to be associated with wound dehiscence more frequently than their counterpart. Conclusion: The current study recommends evaluating patient-related risk factors before to surgery and quickly addressing them. A skilled surgeon should do surgery on high-risk patients. The study contends that the development of wound dehiscence is significantly influenced by baseline traits like age and BMI. The degree of patient cleanliness before surgery greatly influences the likelihood of wound dehiscence. According to the study, other factors that may affect the occurrence of postoperative abdominal wound dehiscence include surgical procedures, skin preparation, the length of the procedure, and the type of wound closure. Coughing, vomiting, and subsequent infection are additional postoperative side effects that increase the risk of wound dehiscence.

General surgery encounter following obstetrics and gynaecological surgeries: A 10 – year review at a university teaching Harcourt

Background: All surgical procedures have potential risk of complications of which obstetrics and gynaecological surgeries are no exception. However, the prognosis of such encounters depends on prompt diagnosis and timely interventions in this scenario by the general surgeons. Aim: To determine the general surgical encounters following obstetrics and gynaecological surgeries at the University of Port Harcourt Teaching Hospital (UPTH): a 10 – year review. Method: This was a 10 –year retrospective review of all the encounters involving the general surgeon following obstetrics and gynaecological surgeries at the University of Port Harcourt Teaching Hospital (UPTH). The information was obtained from the patients case notes. Permission for the study was granted by the ethical committee of the hospital. Data obtained was analysed using SPSS version 25. Results: There were 92 surgical encounters for the period under review. The mean age was 33 ± 2 years. The age range was 20 to 48 years. The modal parity was 2. The marital status of subjects, 60 (65.3%) were married, 26 (28.3%) were single, 4 (4.3%) were divorced and 2 (2.1%) were widowed. The commonest obstetrics and gynaecological surgery was emergency caesarean section 24 (63%) while the most common surgical encounter was incisional hernia 42 (76%). The preferred incision made to repair encounters was mid-line incision 46 (67.4%). Majority of the cadre of surgeons that repaired surgical encounters were consultants 55 (60.9%). Conclusion: The commonest surgical encounter following obstetrics and gynaecological surgery was emergency caesarean section. Incisional hernia was the most common surgical encounter. Prompt diagnosis and intervention by the combined team of the general surgeons and the obstetrician/gynaecologist resulted in favourable outcome. Collaboration between obstetrician and gynaecologist and other surgical specialties cannot be overemphasized for better prognosis in cases of adverse intra-operative encounters.

A Prospective Observational Study of Ventral Hernia.

BackgroundVentral hernias are commonly encountered problems in the field of general surgery. Incisional hernia is a common complication following abdominal surgery that requires reoperation. This study was conducted to understand the incidence of various types of ventral hernia in both sexes and various age groups, predisposing factors, clinical features, and complications.MethodsThis prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India, on a total of 100 patients diagnosed with anterior abdominal wall hernia between September 2020 to February 2021. Data collection included thorough history taking and clinical examination along with relevant investigations. The data collected was entered in a proforma, tabulated, and analyzed with the IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States).ResultsIncisional hernia (43%) was the most common of all ventral hernias. Females were much more affected than males. Out of these types studied, epigastric hernia showed more incidence among males. The average age of presentation was 52 years. Obesity was the most common predisposing factor (34%) with female preponderance. Obese patients were also associated with a higher rate of postoperative complications like wound infection and seroma. In the cases of incisional hernia, 32.6% of the patients gave a history of previous surgery complicated by a wound infection. Incisional hernias were more common in lower midline incisions (34.9%) and after gynecological surgery (55.81%) like total abdominal hysterectomy, cesarean section, or tubal ligation. In the majority of the patients (62.8%), the incisional hernia occurred within three years of the previous surgery. Wound infection following ventral hernia repair occurred in 11% of the cases, wound dehiscence in 3%, and seroma in 2 % of the cases.ConclusionsThe most common ventral hernias in decreasing order of their frequency are incisional hernia, umbilical hernia, para-umbilical hernia, and epigastric hernia. Epigastric and umbilical hernias are more common in males whereas incisional hernia is more common in females. Obesity and constipation were found to be the major predisposing risk factors. Incisional hernia is more common in females after gynecological and obstetrics surgery. The lower midline segment is the most common site for developing an incisional hernia.

562 Midline Versus Off Midline Extraction Site in Laparoscopic Left Sided Colorectal Resections for Colorectal Malignancy: A Systematic Review and Meta-Analysis

Abstract Method To evaluate comparative outcomes of off-midline and midline extraction sites in laparoscopic left sided colorectal resections. Method A systematic search of electronic databases and bibliographic reference lists was conducted, and a combination of free text and controlled vocabulary search was adapted to thesaurus headings, search operators and limits in electronic databases were applied. Studies comparing the outcomes of Off Midline and Midline incisions for specimen extraction in laparoscopic left sided colorectal resections were included. Incisional hernias, surgical site infections, operative time, estimated blood loss, anastomotic leak and length of hospital stay were the evaluated outcome parameters. Results We identified 5 comparative studies reporting a total of 1187 patients comparing outcomes of off-midline (n=486) and midline (n=701) incisions for specimen extraction in laparoscopic left colorectal resections. The off-midline approach was associated with lower post operative surgical site infection (OR 0.71, P=0.68), anastomotic leak (OR 0.76,P=0.66), and incisional hernia (MD: 0.65,P=0.64) compared to midline approach, however it was not statistically significant. There was no significant difference in operative time (MD: 0.10, P=0.99), intra-operative blood loss (MD 2.31, P=0.91), and post-operative hospital stay (MD : 0.78, P=0.18) between the two groups. Conclusions Off-midline extraction site for left sided colorectal resections have no significant difference in rates of post operative surgical site infection and incisional hernias when compared to midline extraction site. No significant difference was found in operative time, intra-operative blood loss, anastomotic leak and post operative hospital stay in this study. Future higher-level research is required to further evaluate the clinical outcomes.

3. Assessment of in vitro dural repair techniques with a hydrostatic pressure device

<h3>BACKGROUND CONTEXT</h3> Incidental durotomies are a relatively infrequent occurrence during lumbar spine surgery and are generally benign, without significant adverse consequences. Treatment with direct repair, with or without augmentation, is generally very effective and further cerebrospinal fluid (CSF) leak is uncommon. The strength and stability of a dural repair is dependent on several factors, including patient age, quality of dural tissue, the size and location of the durotomy, and the manner in which the repair is performed. There is limited in vitro evidence comparing the strength of different dural repair techniques and the resulting likelihood of recurrent CSF leak. <h3>PURPOSE</h3> To compare the strength and stability of various dural repair techniques in an in vitro human cadaveric durotomy model. <h3>STUDY DESIGN/SETTING</h3> An in vitro testing device was created to apply controlled, hydrostatic pressure to evaluate the integrity of a surgically-created durotomy. <h3>PATIENT SAMPLE</h3> Sixteen human cadaveric specimens. <h3>OUTCOME MEASURES</h3> The hydrostatic pressure required to cause a leak at the site of the dural repair. <h3>METHODS</h3> Complete human cadavers were placed in the prone position and the dura in the thoracic and lumbar spines was exposed through a midline incision and subsequent laminectomies. The dura was clamped 8 cm proximal and distal to the level of the durotomy and clamped with reliable, water-tight plastic rings. A 16-gauge plastic catheter was introduced into the lateral aspect of the dura and sutured in a water-tight fashion to serve as the source for instilling saline into the dura. The catheter was attached to a hydrostatic pressure measuring column to assess the intradural pressure. Linear durotomies of either 1 cm or 6 cm in length were made with a 15 blade in both the thoracic and lumbar spines of each cadaver. A dural repair was performed with either a 6-0 prolene or 2-0 silk suture. Repair technique were either multiple, simple interrupted sutures or a simple running repair with knots at the respective margins of the durotomy. An analysis of variant analysis (ANOVA) was employed to assess differences in leak rates with respect to applied hydrostatic pressure. <h3>RESULTS</h3> Eight repair groups (thoracic vs lumbar / 6-0 prolene vs 2-0 silk / running vs multiple interrupted) were studied for each of the 1 cm and 6 cm durotomies. There were no significant differences noted in the frequency or extent of spinal fluid leak at different hydrostatic pressures with respect to either suture type employed or suture technique performed. There was a slight difference in the mean applied hydrostatic pressure applied to create a fluid leak in the 6 cm durotomy (16 cm H2O) compared to the 1 cm durotomy (12 cm H2O) but this did not reach statistical significance. <h3>CONCLUSIONS</h3> In this in vitro study of the integrity of the repair of experimentally created durotomies, no significant difference was noted with respect to different suture type or technique of repair. Larger durotomies had a slight, not significant trend for recurrent leak at lower applied hydrostatic pressures. In general, expansion of the repaired dura with controlled delivery of intrathecal fluid, simulating an in vivo, intraoperative Valsalva maneuver, did not reveal significant differences in varying repair types. While this in vitro study does not directly replicate an in vivo scenario, the results do reinforce the necessity of a meticulous water tight suture repair to adequately treat incidental durotomies and thus avoid the troublesome consequences of a recurrent CSF leak. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

262 Abdominal Hernia Mesh Repair in Patients with Inflammatory Bowel Disease: A Systematic Review

Abstract Aim Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications. Method A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. MERSQI scores were applied along with evidence grades in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185). Results The present systematic search resulted in 11243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate qualities. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition, midline incision site of hernia, biological mesh, and digestive concomitant procedure. Conclusions Patients with IBD were subject, more so than controls, to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.

Risk factors for postoperative ileus after cesarean delivery

Despite extensive data regarding risk factors for postoperative ileus in the general and colorectal surgery literature, few studies have identified risk factors specific to the obstetrical population. This study aimed to identify factors associated with postoperative ileus following cesarean delivery. This retrospective case-control study identified women who underwent cesarean delivery at a single hospital between January 2000 and January 2020 and subsequently developed postoperative ileus. Cases were matched in a 1:2 ratio with controls who underwent cesarean delivery and did not develop postoperative ileus. They were matched by age (±1 year) and body mass index (±1 kg/m2). Demographics, common comorbidities, obstetrical history, and delivery characteristics were analyzed. A total of 147 cases and 294 controls were identified. Cases and controls were similar in terms of parity, number of previous cesarean deliveries, labor preceding their cesarean delivery, incidence of chorioamnionitis, and presurgical diagnosis of hypothyroidism or chronic hypertension. Cases tended to have a diagnosis of preeclampsia (cases 23.1% vs controls 10.5%; P<.001) and were more likely to have been exposed to magnesium sulfate (cases 34.0% vs controls 15.0%; P<.001). Surgical considerations that were common in cases were exposure to general anesthesia (cases 37.4% vs controls 4.1%; P<.001), midline vertical skin incisions (cases 13.6% vs controls 1.4%; P<.001), classical hysterotomy (cases 8.8% vs controls 1.7%; P=.001), estimated blood loss >1000 mL (cases 44.4% vs controls 11.6%; P<.001), transfusion of blood products (cases 25.8% vs controls 2.0%; P<.001), and hysterectomy at the time of cesarean delivery (cases 6.1% vs controls 0.7%; P=.001). After a multivariable modeling using stepwise logistic regression of all variables found to be statistically significant, transfusion of blood products, estimated blood loss >1000 mL, and exposure to general anesthesia were the remaining surgical factors associated with the development of ileus. These variables reflect both the complexity and most likely the duration of surgery that was required, although we note that we did not have operative time as a variable to explore. Preeclampsia was also identified as a comorbidity linked to the development of ileus. A diagnosis of preeclampsia, exposure to general anesthesia, estimated blood loss >1 L, and transfusion of blood products were identified as potential risk factors for postcesarean ileus.

TU2.4 Synthesis review with meta-analysis on risk of incisional hernia following transverse versus vertical midline incision for specimen extraction in patients undergoing laparoscopic colorectal resections

Abstract Objective The objective of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision. Method Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software. Result Twenty-five comparative studies (including 2 RCTs) on 10362 patients fulfilled the inclusion criteria. There were 4944 patIents in the transverse incision group and 5418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development [odds ratio 0.30, 95% CI (0.19–0.49), z= 4.88, p=0.00001]. However, there was significant heterogeneity (Tau2 = 0.97; Chi2= 109.98, df = 24(p=0.00004; I2 = 78%) among included studies. Conclusion Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.

SP10.2.2 Emergency Management of Incisional Hernia

Abstract Introduction Incisional hernia is a common complication after abdominal surgery. Operating on a hostile field renders the management of incisional hernia quite challenging. Presentation with incarcerated or obstructed incisional hernia can further complicate the picture. This study aims to describe the outcomes and burden of emergency management of incisional hernia. Methods A retrospective study has been conducted. We reported the patients' demographics, primary surgery details, hernia characteristics, and mode of presentation and management. Results Forty-five patients were included in the analysis. Mean age was 66.78;SD±15.32. Thirty-one (69%) were females. Mean BMI was 35.49;SD±10.46. They had significant comorbidities including diabetes, CKD, COPD, and malignancy; 31.1%, 13.3%,11.1%, 11.1% respectively. Twenty-two (48.8%) had incisional hernia after midline incision. 25(55.6%) presented with bowel obstruction. Thirty-two had a surgical repair, and ten were managed conservatively. The mean time from admission to surgery was 1.4;SD±2.1. Meshes were used in 10(31.25%) patients. The mean duration of surgery was 114.03;SD±60.55 minutes. Ten patients needed HDU/ITU; 9 of them were managed surgically. Complications rate (CD≥III) was 20%. The 30-day mortality rate was 8.89%. Six (18.75%) patients had recurrence after surgical repair. Thirty patients had CT, 7 had X-rays, and one had US. The mean hospital stay was 8.71;SD±8.8, with an overall hospital stay of 392 days. Fifteen patients were readmitted, and seven came back without staying &amp;gt;24 hours. Conclusion Emergency presentation of incisional hernia carries a high risk of morbidity and mortality and represents a high burden.

EP-85 Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review

Abstract Aims Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications. Method A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. By MERSQI scores quality and evidence classifying were performed in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185). Results The present systematic search resulted in 11243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate quality. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition, midline incision site of hernia, biological mesh and digestive concomitant procedure. Conclusion Patients with IBD were subject, more so than controls, to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.

TH7.10 Extraction site hernias following Laparoscopic Right Hemicolectomy: Does location matter?

Abstract Introduction Laparoscopic colorectal surgery is the gold standard treatment for patients requiring colorectal resection, however the need to exteriorise the specimen and perform extracorporeal anastomosis leads to a risk of incisional hernia. Robotic surgery may facilitate intracorporeal anastomosis which could potentially negate the need for an umbilical extraction site. This study compares current practice of transverse versus midline extraction sites for laparoscopic right hemicolectomy and the incidence of incisional hernia. Methods A retrospective collection of all patients undergoing laparoscopic right hemicolectomy between 2018 and 2020 was performed using OPCS theatre codes. Only those undergoing laparoscopic right hemicolectomy, who had cross-sectional imaging post-operatively were included. Operation notes were scrutinised to identify extraction site and closure method. Post-operative CT scans were reviewed by a radiologist to identify presence of incisional hernia. Results Of 103 patients, 50 met the inclusion criteria. 25 were male. The mean age was 67 (Range = 21–85). 31 patients had midline extraction sites, with 19 having transverse. The average time from operation to CT was 662 days (314–1094) and 34% (n=17) had incisional hernia identified on a CT scan post-operatively. Midline extraction sites were associated with a significantly higher rate of incisional hernia when compared to transverse sites (n=16/31, 1/19; p&amp;lt;0.01). Conclusion Transverse extraction sites are associated with a lower risk of incisional hernia after laparoscopic right hemicolectomy and should be preferred to midline incisions where possible. As intracorporeal anastomosis becomes a more established technique, further work is needed to determine optimum extraction site to further reduce the risk of incisional hernias.

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART).

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. ISRCTN25616490 (http://www.controlled-trials.com).

Narcotic waste in the operating room and immediately post operatively in gynecologic oncology surgery (118)

Narcotic waste in the operating room and immediately post operatively in gynecologic oncology surgery (118)

Inguinal Hernias After Lower Midline Incision Surgery: Clues for Considering Inguinal Hernia in Females and Males: a Literature Review

Inguinal Hernias After Lower Midline Incision Surgery: Clues for Considering Inguinal Hernia in Females and Males: a Literature Review

Comparison of the Results of Electrocautery and Scalpel Use in Abdominal Midline Incisions

Objective: Scalpel is the conventional instrument for laparotomy incisions. Electrocautery, on the other hand, can offer potential advantages such as blood loss, incision time, postoperative pain. In this study, we aimed to compare the clinical results of electrocautery and scalpel in abdominal midline surgical incisions. Method: 146 cases who underwent elective abdominal midline incision between January 2020 – December 2021 were included in the study. The patients were divided into two randomized groups as electrocautery (n: 78) and scalpel (n: 68). The incision dimensions, incision time and blood loss during incision were noted intraoperatively. Postoperative pain and wound infection were recorded. Results: The age and sex distribution was similar in the two groups. Incision time(seconds) in the electrocautery group (35.4±18.1) (57.6±25.3) was significantly shorter compared with the time in the scalpel group(p

Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery

ObjectivesThe use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions. DesignRetrospective cohort study. SettingTwo Level-1 trauma centers. Patients/ParticipantsPatients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating. InterventionDual plating through either a single anterior incision, or dual medial/lateral incisions. Main outcome measurementsRates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05). Results and conclusionsIn total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p<0.001). There were no significant differences in any demographic parameters between patients undergoing single versus dual plating. Although retrospective, not randomized and subject to single surgeon bias these data suggest that these complications are more based on injury than the approach. Level of evidenceIII

Analgesic efficacy of erector spinae plane block versus rectus sheath block in adults undergoing open para-umbilical hernia repair

Background: Rectus sheath block (RSB) is a popular technique for post-operative analgesia for patients undergoing abdominal surgeries with midline incisions. Ultrasound-guided erector spinae plane block (ESPB) is an interfacial plane block for the treatment of post-operative neuropathic pain. The aim of this study was to compare the analgesic efficacy of ESPB versus RSB in adult patients undergoing open para-umbilical hernia repair. Methods: This prospective randomized double-blinded study was carried out on seventy-four adult patients with ASA physical status I-II undergoing open paraumbilical hernia repair. Patients were divided into two equal groups: group I (ESPB): patients received bilateral ultrasound-guided ESPB using bupivacaine 0.25% (20 ml) on each side and group II (RSB): patients received bilateral ultrasound-guided RSB using bupivacaine 0.25% (20 ml) on each side. The following measurements was recorded: VAS score, intraoperative fentanyl consumption, the time to the first postoperative rescue analgesia administration, total dose of postoperative rescue analgesia (morphine) consumption, heart rate and mean arterial blood pressure.

Safety and feasibility of laparoscopy-assisted surgery for gastrointestinal stromal tumors larger than 5 cm: Results of a retrospective, single-center series of 1,802 consecutive patients

BackgroundThe role of laparoscopy-assisted resection for treating gastrointestinal stromal tumors >5 cm is still disputed. We aimed to assess the advantages of laparoscopy-assisted resection for treating gastrointestinal stromal tumors >5 cm. MethodsIn total, 1,802 patients with primary gastrointestinal stromal tumors who underwent laparoscopy-assisted surgery or open surgery were retrospectively evaluated. Propensity score matching was performed to reduce confounders. ResultsIn total, 518 patients with tumor size >5 cm were enrolled in this study (males: 292, 56.4%; females: 226, 43.6%; median age: 58 years, range: 23–85 years). One hundred and twenty-three (23.7%) patients underwent laparoscopy-assisted resection, and 395 (76.3%) patients underwent open resection. After propensity score matching, 190 patients were included (95 in each group). The laparoscopy-assisted surgery group was superior to the open surgery group considering the blood loss (>200 mL: 6.3% vs 22.1%, P = .005), length of midline incision (6.0 ± 0.9 cm vs 9.6 ± 2.1 cm, P < .001), time to first flatus (49.7 ± 10.5 hours vs 63.9 ± 7.4 hours, P < .001), and shorter hospital stay (10.3 ± 3.2 days vs 11.9 ± 2.9 days, P < .001). The difference in relapse-free survival or overall survival between the laparoscopy-assisted surgery and open surgery groups after matching was not significant (all P > .05). On subgroup analysis, the relapse-free survival and overall survival of the laparoscopy-assisted surgery group were comparable to those of the open surgery group, irrespective of tumor location (gastric or nongastric locations) (all P > .05). ConclusionWhen performed by experienced surgeons, laparoscopy-assisted resection is feasible and safe for gastrointestinal stromal tumors >5 cm, which showed improved short-term outcomes and comparable oncological outcomes, regardless of whether the tumor had a gastric or nongastric location.