Non-packing Group Research Articles

WITHDRAWN: Clinical observation of 19 primary pituitary abscess cases treated by transsphenoidal surgery with or without sella packing

ObjectivePituitary abscess (PA) is a rare disease in the sellar region. This study aimed to investigate a series of PA cases with two different approaches to better understand the surgical principles and underlying mechanisms. Methods19 cases of primary PA were included for a comprehensive evaluation with special attention paid to the surgical approaches and the effectiveness and safety with or without sella packing. ResultsHeadache, and visual impairment were the most frequently seen symptoms among all patients. More than half of patients exhibited anterior pituitary dysfunction including panhypopituitarism, with a considerable portion of patients found with elevated prolactin (PRL) along with a thicker stalk on MRI. 11 patients underwent transsphenoidal surgery (TSS) without sella packing for allowing continuous drainage (Non-packing group), while the remaining 8 were operated with fat-based packing following intraoperative pus irrigation (Packing group). Both groups had similarly good outcomes including the duration of antibiotics use, complications, and hospital stay, but the incidence of abscess recurrence was higher for the packing group. ConclusionTSS without sella-packing exhibited comparable safety to the packing approach for PA and may be associated with a lower incidence of recurrence, provided that cerebrospinal fluid (CSF) leakage is well prevented.

Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial.

Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes. The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale). Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20). Avoiding abscess cavity packing is less painful without a negative morbidity risk. ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484). NCT03315169 (http://clinicaltrials.gov).

Is Nasal Packing Necessary After Endoscopic Dacryocystorhinostomy Without Stent and Mucosal Flaps Preservation?

This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps. The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups. Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76). The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.

To pack or not to pack- A Randomized Clinical Trial comparing the Immediate Outcomes of Packed and Non Packed abscess wounds

Introduction: The objective of this study was to determine if there was any benefit from routine abscess packing after incision and drainage as compared to incision and drainage alone, as there seems to be emerging literature negating this practice.&#x0D; Methods: A prospective randomized study incorporating abscess from different locations of the body, measuring less than 7 cm, were taken. Incision and drainage was carried out under local or general anesthesia after routine preparation by the surgical resident under guidance of the surgical registrar. The subjects were then randomized into abscess cavity packing and non-packing groups with prescription for antibiotics, analgesics and narcotic analgesics. The subjects were followed up in surgical outpatient by the same resident, where the wound was examined, pain was noted for the duration using the VAS and number of narcotic analgesics taken were noted.&#x0D; Results: Total of 92 patients was included divided equally in both groups. There was equality within the two groups regarding age, sex and location of abscess. The primary outcome, which was to find out the need for intervention in the first 48 hours after the procedure was compared and there was no significant difference in the interventions needed in the first 48 hours between the two groups (p= 0.49, difference in means =.536, 95% CI = -2.14 to 1.07). There was no difference in the overall pain perceived by the patients of the two groups, as the total patients who experienced pain were 77, of which 41(53.2%) were in the wound packed group and 36 (46.8%) non-packed group, (difference in means = 0.783, 95% CI= 0.40 to 1.16, p=0.75), but of the 19 patients who experienced severe pain, 15 were from the packed group and 4 were from the non-packed group (p = 0.02). 29 patients from the packed group required narcotic analgesics whereas only 12 from the non-packed group required them (p=0.009, 95% CI= 0.20 to 0.58).&#x0D; Conclusion: Packing of the abscess cavity does not carry any added benefit as compared to Incision and Drainage alone and it causes more severe pain and discomfort to the patient with increased analgesic requirements.

A study evaluating the effects of throat packs during nasal surgery: a randomised controlled trial.

The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.

A Randomized Controlled Trial Comparing Packing with Nonpacking of Perianal Abscess Cav

Introduction: Anorectal abscess is a potentially debilitating condition and one of the common anorectal conditions encountered in practice. Anorectal abscesses are defined by the anatomic space in which they develop and are more common in the perianal and ischiorectal spaces. Traditional management of perianal abscess involves early incision, drainage, curettage and packing of the residual cavity. Cavity packing and dressings are problematic in that they cause significant discomfort and require multiple visits to change the packing until healing. An alternative to the traditional approach is to perform adequate incision and drainage and then to allow healing without the use of cavity dressings.&#x0D; Objective: To compare the effects of packing with nonpacking of the perianal abscess cavity on patient discomfort and wound healing and subsidiary evaluation of the clinical outcomes.&#x0D; Materials and Methods: This single centre randomized controlled trial was carried out on 50 patients who were operated upon for perianal abscess in Combined Military Hospital, Dhaka during the period of July 2014 to June 2016. Patients were randomly assigned to receive either packing or nonpacking treatment through allocation by sealed envelope. The packing (control) group was instructed to report to a single nursing staff for subsequent dressing with packing of the residual cavity. The nonpacking group was discharged with a superficial protective dressing; they did not undergo wound dressing but managed their own wounds until follow-up. Outcome measures were time of healing, abscess recurrence, fistula formation and post operative pain.&#x0D; Results: A total of 54 patients were enrolled (4 lost in follow-up): 24 in the packing and 26 in the nonpacking arm. The two groups were comparable in terms of age and gender distribution, type, size of the abscess, duration of symptoms and length of follow-up. Healing in the non-packing group was faster compared to that of the packing group: mean 24.08 days versus 34.13 days (P=0.000). The rate of abscess recurrence was similar (P=0.664). Post operative fistula rates were similar (P=0.623). Pain scores appeared less in the nonpacking arm and statistically significant (7.25 vs. 4.24, P=0.000).&#x0D; Conclusion: Small size of the study population was the limitation of this study. In order to obtain a higher level of evidence, an adequately powered multicentre based prospective randomized controlled trial is required to definitely address the question of packing of the cavity and its beneficial outcome following incision and drainage in the management of perianal abscess.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 111-116

Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis.

Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method. We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze. Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively. Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia. 1B Laryngoscope, 127:1026-1031, 2017.

Internal dressings for healing perianal abscess cavities.

Internal dressings for healing perianal abscess cavities.

Efficacy and safety of pelvic packing after emergency peripartum hysterectomy (EPH) in postpartum hemorrhage (PPH) setting

ObjectivesTo study the safety and effectiveness of pelvic packing in the control of post emergency peripartum hysterectomy (EPH) bleeding in a postpartum hemorrhage (PPH) setting. Study designFrom 39 patients with a severe PPH leading to an EPH (January 2010–December 2013), we identified a group of 17 patients requiring a pelvic packing (packing group) and a second group of 22 patients not requiring a pelvic packing (non-packing group). For each group, transfusion requirements were recorded from time of PPH diagnosis to end of the surgical procedure (P1: Period 1) and from that point to the end management in the SICU (P2: Period 2). Laboratory values, transfusion requirements and complications were compared between the 2 groups. Statistical comparisons were performed using Mann–Whitney test, Fisher's exact test and chi-square test. A p-value <0.05 was considered statistically significant. ResultsPelvic packing was successful in the control of bleeding in all the cases. During the second laparotomy for pack removal, none of the patients developed complications such as bowel injuries or necrosis. The 2 groups were similar in term of laboratory values at the end of the surgical procedure and 24h after the end of the surgical procedure. The number of PRBC units required in P1 was higher in the packing group compared to the non-packing group (16.6±5.3 vs 14±5; p=0.04), however the decrease in the amount of PRBCs transfused between P1 and P2 was higher in the packing group (13.3) compared to the non-packing group (9.1) (p<0.01). The incidence of febrile morbidity was higher in the packing group compared to the non-packing group (53% vs 9%; p=0.04); but no significant difference was shown in term of generalized sepsis, as well as renal failure, ARDS, deep vein thrombosis, pulmonary embolism and MOF. ConclusionThe pelvic packing is a valuable method with a high success rate in the control of hemorrhage after an EPH in PPH setting with a low rate of complications. It is quite simple and quick to perform, and therefore should be kept in mind by all obstetricians as a lifesaving technique.

Biodegradable nasal packings for endoscopic sinonasal surgery: a systematic review and meta-analysis.

ObjectivesTo assess biodegradable nasal packing effectiveness for improving postoperative symptoms and mucosal healing after endoscopic sinonasal surgery as compared with conventional/non-packing groups.MethodsRelevant articles were searched on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials (RCTs) that compared biodegradable packings with conventional packings or no packing, reporting postoperative symptoms and/or mucosal healing outcomes.ResultsThis review included 19 studies, of which 11 compared biodegradable packings with conventional packings. Meta-analysis found that biodegradable packings significantly improved postoperative symptoms: bleeding at removal, pain at removal, pain in situ, and nasal blockage. Mucosal healing outcomes were inconsistent within studies, with no data could be pooled. Eight studies compared biodegradable packings with non-packing group. Postoperative symptom data in this comparison could not be pooled: A protective or equal effect on postoperative bleeding was reported in different studies; no difference was reported in pain status and nasal blockage. As for mucosal healing, meta-analysis showed that two arms of comparison had similar effect on synechiae, edema, infection and granulation at each time point.ConclusionThe limiting evidence suggests that biodegradable nasal packings are statistically better than conventional packings in postoperative symptoms, and probably comparable to non-packing group, as in this comparison we could not carry out meta-analysis. No beneficial or detrimental effect on postoperative mucosal healing could be determined based on existing evidence.

Incision and drainage of subcutaneous abscesses without the use of packing

PurposeThe classic intervention for subcutaneous abscesses is incision and drainage followed by wound packing. This is thought to aid hemostasis, and prevent reorganization of the abscess. Removal of packing material may be painful and anxiety provoking. We sought to determine whether packing could be omitted with equal efficacy. MethodsOne hundred pediatric patients with subcutaneous abscesses were enrolled between May, 2008 and December, 2010. All underwent incision and drainage, then seven days of oral antibiotics and warm soaks. Patients were randomized to the packing group (PG) or non-packing group (NPG). Packing was removed 24h after the procedure. Patients were excluded if: 1) diabetic/immunosuppressed, 2) the abscess was perianal or pilonidal, or 3) the abscess was secondary to a previous operation. Patients were evaluated in clinic if recurrence was suspected during follow-up calls on postoperative days seven and 30. ResultsEighty-five patients completed the study (43 PG/42 NPG). The two groups were not statistically different with respect to initial parameters, recurrent abscesses (one in each group), or MRSA incidence (81.4% PG/85.7% NPG). ConclusionIncision and drainage of subcutaneous abscesses without the use of packing is a safe and effective technique. This approach omits a traditional, but painful and anxiety provoking, component of therapy.

Trans-septal suturing technique in septoplasty: a systematic review and meta-analysis.

Trans-septal suturing techniques are routinely used to obviate the need for packing after septoplasty surgery. This study aimed to systematically assess the evidence for the efficacy and safety of suturing techniques after septoplasty. A MEDLINE, Scopus, Cochrane Library, and ProQuest Dissertations & Thesis Database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied. Only prospective randomized controlled trials (RCTs) comparing trans-septal suturing techniques following septoplasty with conventional packing were included. For each outcome, risk difference and 95% confidence intervals (CIs) were calculated. Tests for heterogeneity and tests for publication bias were applied. Eight RCTs with 869 patients were included in the review. Postoperative pain and headache were significantly lower in the non-packing group. Conventional packing and trans-septal suturing technique appear to be equivalent with regard to postoperative haemorrhage risk, mucosal adhesions, septal perforation, septal haematoma and local infection. The evidence for the advantage of suturing techniques over conventional packing in septoplasty is now robust, and the use of suturing techniques as a first line intervention is becoming advisable.

Randomized Trial Comparing Wound Packing to No Wound Packing Following Incision and Drainage of Superficial Skin Abscesses in the Pediatric Emergency Department

The objective of this study was to investigate the impact of wound packing versus no wound packing on short-term failure rates and long-term recurrences after incision and drainage (I&D) of a simple cutaneous abscess. In this randomized, single-blind, prospective study, subjects between the ages 1 and 25 years with skin abscesses needing an I&D were enrolled consecutively and randomized to be packed or not packed following the procedure. Treatment failure was assessed at a 48-hour follow-up visit by a masked observer who rated the need for a major intervention (repeat I&D or re-exploration) or minor intervention (antibiotics initiated or changed, need for packing, or repeat visit). Pain scores were assessed using color analog scales before and after the procedure and repeated at the 48-hour follow-up visit. Healing and abscess recurrence were assessed via telephone interview at 1 week and 1 month. Fifty-seven subjects were enrolled over a 15-month period. Overall failure rates were similar between the groups, with 19 (70%) of 27 subjects in the packed group needing an intervention by 48 hours compared with 13 (59%) of 22 subjects in the nonpacked group who needed an intervention (difference, 11%; 95% confidence interval, -15% to 36%). Major and minor intervention rates were also similar. Pain scores did not significantly differ between groups. Wound packing does not appear to significantly impact the failure or recurrence rates after simple I&D. Larger studies are needed to better validate the equivalency of these 2 strategies.

The need for intranasal packing in endoscopic endonasal surgery

Conclusion: The present findings indicate that conventional nasal packing is not required for endoscopic endonasal surgery. Objectives: To evaluate the routine use of packing in endoscopic endonasal surgery. Methods: From January 2006 through January 2009, 146 consecutive patients who underwent endoscopic endonasal surgery performed by the same surgeon in Kyoto University Hospital were evaluated. The surgical procedure was ended with conventional gauze packing in 70 consecutive patients from January 2006 through August 2007 (Packing group), and placing of oxidized cellulose on operative sites was performed in 76 consecutive patients from September 2007 to January 2009 (Non-packing group). We analyzed demographic characteristics, comorbidities, surgical procedures, incidence of packing the nose after excessive postoperative bleeding, and occurrence of postoperative adhesion. Results: No significant differences in the demographic characteristics, except for gender, and in comorbidities were found between the two groups. The number of endoscopic sinus surgery procedures with septoplasty and/or turbinoplasty, or tumor extirpation in the Non-packing group was significantly larger than that in the Packing group. There was no significant difference in the incidence of postoperative bleeding or postoperative adhesion between the two groups.

Wintering of Bees in Minnesota1

Colonies of the University apiaries were divided into three groups of about equal strength. The colonies in one group were not packed, in another a light packing was applied, and those of the third group were heavily packed. Ample stores were left for wintering. The average mortality for the period of 1943-1944 to 1953-1954 was 18.4%, 6.4%. and 2.9% for the non-packed, lightly packed and heavily packed groups, respectively. When the weak and queen less colonies were also counted, the losses were 34.3%, 15.2% and 10.5% for the above mentioned groups, respectively. The heavily packed group had, on an average, 25.0% and the lightly packed 19.2% more frames of brood in the spring than did the non-packed group.