Tissue Bites Research Articles

Impact of small-bite (5 mm) fascial closure on the incidence of incisional hernia following open colorectal cancer surgery: randomized clinical trial.

Incisional hernia is frequently observed after open colorectal cancer surgery, and should be considered a serious short- and long-term health issue. The present study evaluated the efficacy of small-bite abdominal closure in reducing the incidence of incisional hernia in this patient group. An RCT was conducted between June 2019 and June 2022. A total of 173 patients who underwent open colorectal cancer surgery were assigned randomly to one of two groups to undergo fascial closure with either small bites (87) or conventional bites (86). The incisional hernia rate was accepted as the primary outcome, and surgical-site infection as the secondary outcome. The incisional hernia rates at 1 year were 7 and 27% in the small- and conventional-bite groups respectively (P < 0.001). This rate increased to 9 and 31% at the end of the second year (P < 0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P = 0.03). Compared with the conventional-bite group, the small-bite group had higher suture/wound length ratios (mean(s.d.) 5.18(0.84) versus 3.67(0.57); P < 0.001) and a longer fascial closure time 14.1(4.64) versus 12.9(2.39) min; P = 0.03). Small-bite closure with 5-mm tissue bites placed 5 mm apart reduced the incidence of incisional hernia and surgical-site infection after open colorectal cancer surgery.

Sequestered, Iatrogenic Epidermoid Implantation Cysts Associated With Retroauricular (Wilde's) Incision.

To report two patients with iatrogenic, epidermoid implantation cysts associated with the standard retroauricular (Wilde's) incision, to establish their etiology, to explore means to prevent them, and to ensure that this experience adds to the learning curve of the surgical training of the residents. Case series with the review of literature. One of the two patients, who had an unremarkable follow-up period after cortical mastoidectomy and cartilage tympanoplasty performed three years back, presented with a retroauricular cystic swelling visible since two months. It was hyperintense on T2-weighted magnetic resonance imaging. A sequestered cystic mass was encountered at surgery in the subcutaneous plane in association with the retroauricular scar tissue from previous surgery. In the other patient, two similar cysts (one of them sequestered) were incidental findings at revision tympanomastoid surgery. Histopathology in both instances was consistent with epidermoid cyst. Given their subcuticular location and intimate association with a pre-existing surgical scar, they were considered to be of implantation in origin. This was a potential outcome of persistent inversion of one or both skin edges following simple interrupted suturing. The reason could be a faulty surgical technique, due to improper placement of the needle with respect to skin, inadequate or uneven tissue bite, a tight knot, or failure to manually evert the apposing edges at the point(s) of suspicion. Sequestered epidermoid implantation cysts due to persistent inversion of sutured skin edges are unusual complications. The illustrations in this case series emphasize the need to adhere to the basic principles of surgical practice. They provide a caveat to the resident surgeons and the faculties who supervise them, that inadvertent and apparently innocuous misses, even at the elementary steps of surgery (like suturing), could lead to complications that are unwanted and potentially avoidable.

Comparison of three purse-string suture techniques for prevention of anal leakage during surgery

To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure. 18 large-breed canine cadavers. 3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques. Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C. Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.

Clinical and histopathological correlation in patients with chronic tonsillitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic tonsillitis is diagnosed when an individual has 7 episodes of tonsillitis in 1 year, 5 episodes in 2 consecutive years, or 3 episodes each year for 3 years consecutively. There is correlation of clinical and histopathological findings in patients with chronic tonsillitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is prospective study which is aimed at correlation of clinical and histopathological findings in chronic tonsillitis patients underwent tonsillectomy. This was carried out in tertiary care hospital, Pune, Maharashtra, India. In our study, 25 patients of chronic tonsillitis underwent tonsillectomy were included. In this we have examined the histopathology of tonsillar tissue section in correlation with the clinical manifestations of tonsillar diseases that were due to infection. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In pathological examination of palatine tonsil, underlying subepithelial tissue showed many lymphoid follicles with prominent germinal centres comprising of centrocytes, centroblasts, immunoblasts, small and large lymphocytes in 19 patients (76%). 13 patients (52%) showed prominent germinal centres with bites of salivary gland and muscle tissue. 6 patients (24%) showed prominent germinal centre with mild lymphoplasmocytic inflammatory cell infiltrate. In 4 patients (16%), tissue lined by stratified squamous epithelium showed focal ulceration. 3 patients (12%) showed stratified squamous epithelium with granulation tissue. Crush artifact were noted in 3 patients (12%). 2 patients (8%) had small granules with actinomycotic species colonies within the palatine tonsilar crypts. Only 1 patient (4%) showing keratin impacted in tonsilar tissue.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is strong correlation between histopathological examination suggestive of lymphoid hypertrophy and grading of palatine tonsil hypertrophy.&lt;/p&gt;

Experience of small tissue bites with conventional tissue bites in emergency setting for midline abdominal wound closure

Background: Midline incision provides excellent access to the abdominal cavity. However, wound infection following a laparotomy can increase morbidity as well as burden on health care system. Wound prognosis can be influenced by the type of incisions, suture material and the method of closure. This study aimed to assess the outcome of midline abdominal wound closure using two different techniques of wound closure.Methods: This was a prospective observational study and consisted of 300 consecutive patients ≥18 years of age undergoing abdominal surgery through a midline incision in emergency setting. Patients who were included in the study were then randomised into two groups. In group I, midline laparotomy was closed with large tissue bites and in group II small tissue bites were used.Results: Out of 300 patients included in this study, 150 patients were subjected to large tissue bites and another 150 patients to small tissue bites. 29 patients out of 150 patients (19%) in large tissue bites group and 16 patients (11%) in small tissue bites developed surgical site infection (SSI). 23 patients out of 50 patients (15%) in large tissue bites group and 11 patients (7%) in small tissue bites developed wound dehiscence.Conclusions: In this study, we found that the patients in group II whose midline laprotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

Comparative Study on TGF-β Expression of Large Continues and Small Continues Stitch Technique Using Polyglecaprone 25 on Abdominal Skin Incision in Rattus Novergicus

Ideal closing of the abdominal wound will provide strength and prevent infection. Abdominal wall closure method is an important aspect of effective incision closure, besides the choice of suture material. TGF-β generally involved in wound healing process. The suture technique is also important in wound healing process. This study aims to compare the large stitch technique with the small stitch technique for abdominal skin closure. Twenty rats were used in 4 groups. The small stitch group received small tissue bites of 5 mm from wound edge, and the large tissue group received large bites of 10 mm from wound edge. The incision of the skin was closed by running suture using polyglecarprone 25. Animal model were euthanized on the 4th and 7th day post incision. Tissue section were examined using immunohistochemistry method to measure TGF-β expression. The results were analyzed using t-test and the effect size. Rats in the small stitch group had higher TGF-β expression on day 4th and 7th than those in the large stitch group. TGF-β expressions in the small stitch group were 0,87 -fold greater on day 7th than day 4th and were 0,71 -fold greater in the large stitch group (p = 0,410). The significance analysis on day 4th with a result of 0,082 and day 7th with a result of 1.48, which means day 7th showed high effect (Cohen's d&gt; 0.8) on wound healing than day 4th. In conclusion, polyglecaprone 25 use as a suture material on the day 7th showed a high effect in terms of TGF- β expression.

Small bite closure in midline laparotomy; A practice to reduce the surgical site infection, wound dehiscence, and incisional hernia

Background: Postoperative wound site complications are a significant source of morbidity after midline laparotomy. The study's objectives were to compare the two suture patterns for fascial closure in midline abdominal wounds and their effect on postoperative wound site complications. Materials and Methods: Over 4 years, the prospective comparative study was conducted at the Government Medical College Hospital, Srinagar. All the patients ≥18 years and ≤70 years of age underwent midline laparotomy for various indications were included. Patients were randomized to two groups using computer-generated numbers based on closure techniques. Group A; Large Tissue Bite closure (10 mm from the wound edge and 10 mm apart and Group B; Small Tissue Bite closure (5–7 mm from the wound edge and 5–7 mm apart). Effect of age, sex, body mass index (BMI), albumin, and suture bite on postoperative complications were analyzed. Results: Among 324 patients who met the inclusion criteria, the mean age was 39.17 years, 84.56% were male with a Male: Female ratio of 5.48. Two hundred and two (62.35%) patients had large tissue bite closure, and 122 (37.75%) had small bite closure. There was no statistically significant difference between the two groups concerning age, sex, albumin levels, BMI, and type of surgery. About 35.64% of patients in the large tissue bite closure group and 19.67% patients in small bite closure developed surgical site infection (SSI) (P = 0.002). The difference in wound dehiscence between the two groups (15.84% vs. 7.38%) was statistically insignificant (P = 0.29). In midline laparotomy closure, the small bites technique results in significantly less incisional hernias than the large bites technique (P = 0.00001). None of our patients expired during the study period. Conclusion: The small bite technique substantially reduces SSIs, wound dehiscence, and incisional hernia. The accident-emergency and general surgery residents, in particular, should be made familiar with this technique to avoid postoperative wound site complications and improve the quality of postoperative life.

TGF-β expression on different suturing technique for abdominal skin wound closure in rats

BackgroundThe method of closing the abdominal wall, as well as, the choice of material for stitching are important aspects of efficient incision closure. Generally, transforming growth factor-beta (TGF-β) is involved in the wound healing process. Suturing procedures also play a part in the wound dehiscence occurrence. This study aimed to compare TGF-β expressions in rats after using the large stitch vs. small stitch technique for abdominal skin wound closure. MethodsA total of twenty Wistar rats (Rattus norvegicus) were used in this experiment. Small tissue bites of 5 mm were obtained by the small stitch group and the large stitch group received large bites of 10 mm. Abdominal skin incisions were closed by running sutures. On days 4 and 7, the animals were euthanized. For TGF-β expressions, histological parts of the tissue-embedded sutures were analyzed. With significance set at p < 0.05, two-way ANOVA showed that on days 4 and 7, the TGF-β expressions of the rats in the small stitch group were nearly identical to those in the large stitch groups. ResultsAfter including twenty rats in this study, results showed the TGF-β expressions on days 4 and 7 in rats in the small stitch group were equivalent to those in the large stitch group. (p = 0.45). ConclusionsBetween the small and the large stitch groups, the TGF-β expressions are similar, suggesting that the suturing methods do not have any significantly different beneficial impact on the frequency of wound dehiscence.

Repeated partial tissue bite with inadequate cooling time for an energy device may cause thermal injury.

Over the past three decades, the use of ultrasonically activated device (USAD) and advanced bipolar device (ABD) has grown in minimally invasive surgeries. However, the thermal profile differences during repeated dissection with different grasping ranges of energy devices, which provide valuable information for preventing thermal injury by energy devices, remain unclear. We developed an ex vivo benchtop model to examine the temperature profile of the blade and jaws of two USADs (HARMONIC® ACE + and Sonicision™) and a ABD (Ligasure™ Maryland) with different grasping ranges (partial tissue and full tissue bite) in repeated dissection with minimum cooling time. The maximum temperature, time required for completion to dissection of 10cm of porcine muscle, thermal spread, and cooling time to reach 60°C were continuously measured using video thermography. In addition, to evaluate one more grasping range "no tissue", we performed a stress test that activated the USAD without tissue intervention to assess the effects of excessive load on the blade and jaw. Repeated dissection of energy devices with minimal cooling time results in high blade and jaw temperatures proportional to the incision distance. In particular, the USADs with partial tissue bite showed a significantly higher temperatures at the blade and jaw, longer cooling times, and higher lateral thermal spread than those with a full tissue bite and the ABD. The stress test with a USAD showed an extremely high blade temperature exceeding 400°C, with the tissue pad melting only 13.2s after activation. Although USAD with partial tissue bite help ensure precise dissection, repeated long activation with inadequate cooling time may increase the risk of thermal injury during surgery. These results suggest that surgeons should use energy devices properly while understanding the risks of adjacent organ damage that could result from abuse of the device.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Ultrasound Imaging of the Superficial Fascial System Can Predict the Subcutaneous Strength of Abdominal Tissue Using Mean Gray Value Quantification.

This study is the first to correlate sonographic findings of subcutaneous tissue to structural and biomechanical properties. Precisely sized tissue specimens (59 samples) were collected from five abdominoplasty procedures. A Philips Lumify L12-4 linear array probe, connected to an Android tablet, was used to obtain ultrasound images of the superficial fascial system. A no. 1 Vicryl suture on a CTX needle placed though a needle guide within a three-dimensionally printed template ensured equal bites of subcutaneous tissue across specimens. Suture pull-out strength was measured until failure at a displacement rate of 2.12 mm/second using an Admet MTEST Quattro. Mean gray value for the superficial fascial system in associated ultrasonographic images was quantified by CellProfiler. Superficial fascial system visualization can be accomplished using high-resolution portable ultrasound. Comparing multiple specimens' imaging, interpatient and intrapatient variability of superficial fascial system quantity and structural characteristics are apparent. The superficial fascial system is highly abundant in some patients, but has limited presence in others. Individual-specimen mean gray value and whole-patient mean gray value positively correlated with tissue tensile strength (p = 0.006) and patient-average tissue tensile strength (p = 0.036), respectively. Whole-patient mean gray value accounted for 98.5 percent of the variance seen in patient-average tensile strength, making it a strong predictor for tensile strength. Portable ultrasound and image-processing technology can visualize, quantify, and predict subcutaneous tissue strength of the superficial fascial system. The superficial fascial system quantity correlates with suture tensile strength. Clinically, preoperative superficial fascial system quantification may aid in outcome predictions, manage patient expectations, and potentially lower complication rates. Diagnostic, V.

Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections.

Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.

Suture length to wound length ratio in 175 small animal abdominal midline closures.

Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.

Suture length to wound length ratio for simple continuous abdominal closures in veterinary surgery: An experimental in vitro study.

ObjectiveThis study aimed to investigate the suture length to wound length ratio (SL:WL) in an in vitro model of abdominal wall closure. Effects of the surgeon’s experience level on the SL:WL ratio were evaluated, hypothesizing that small animal surgeons do not spontaneously apply SL:WL ratios equal to or larger than 4:1.ProceduresThree groups of surgeons with varying levels of experience performed 4 simple continuous sutures before (3 sutures) and after (1 suture) being educated on principles of the SL:WL ratio. All sutures were evaluated for their gaping, number of stitches, stitch intervals, tissue bite size and suture length.ResultsNo significant differences in suture parameters or SL:WL ratios were found among the 3 groups, and 60.5% of control sutures and 77.0% of test sutures had SL:WL ratios above 4:1. There was a significant improvement in the mean ratio after the information was provided (p = 0.003). Overall, the SL:WL ratios ranged from 1.54:1 to 6.81:1, with 36.3% falling between 4:1 and 5:1 (5.17 mm mean stitch interval, 5.52 mm mean tissue bite size). A significant negative correlation was observed between the SL:WL ratio and the stitch interval to tissue bite ratio (r = -0.886). Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1.ConclusionA SL:WL ratio larger than 4:1 was achieved in 60% of the control sutures and in 77% of test sutures. Additional animal studies are necessary to evaluate the SL/WL ratio in small animal surgery.

Complete intracorporeal defect closure using unidirectional barbed suture in laparoscopic incisional hernia repair: Preliminary experience with short-term follow-up.

Surgical techniques to close defects in laparoscopic incisional hernia repair vary across the literature. We herein demonstrate our original and standardized surgical technique for laparoscopic incisional hernia repair with complete intracorporeal defect closure using barbed suture. Complete intracorporeal defect closures were indicated for defects less than or equal to 6 cm in transverse diameter. We performed a defect closure with a running suture using barbed suture in a caudal to cranial direction, with tissue bites and inter-suture spacing of 1 cm each. The hernial sac was incorporated into the suturing to reduce possible dead space. After the procedure, intraperitoneal onlay mesh was placed. Seven patients underwent this procedure. The median total operative time was 188 min, and the median time specifically for defect closure was 25 min. There was no seroma, mesh bulge, persisting pain, or hernia recurrence at follow-up. Our proposed technique is simple and can be safely performed with good short-term outcomes.

Vaginal Cuff Dehiscence and Evisceration: A Review.

Vaginal cuff dehiscence is an infrequent complication of hysterectomy, with the potential for evisceration and additional morbidity. This review aims to describe the incidence, risk factors, preventative measures, and management. Identification of specific risk factors is problematic because many studies either lack comparison groups or are underpowered as a result of the rarity of this complication. Good surgical technique to optimize vaginal cuff healing and minimize the risk of postoperative cuff infection are important as is avoidance of early intercourse, traumatic vaginal penetration, or excess strain on the vaginal cuff during the postoperative period. Judicious use of electrocautery or other thermal energy, use of delayed absorbable sutures, and adequate tissue bites can further decrease the risk of dehiscence. Prompt recognition and management are critical to achieve best outcomes.

Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review.

The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12months, and the secondary outcomes were burst abdomen and surgical site infection. A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed. A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.

An Observational Study of Midline Abdominal Wound Closure Using Small Tissue Bites versus Large Tissue Bites with Reference to Surgical Site Infections and Wound Dehiscence

Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients; small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.

Development of incisional herniation after midline laparotomy.

BackgroundIncisional herniation is a common complication after abdominal surgery associated with considerable morbidity. The aim of this study was to determine whether incisional hernia is an early complication, in order to understand better the aetiology of incisional hernia formation.MethodsThis study involved the secondary analysis of a subset of patients included in a large RCT comparing small and large tissue bites (5 mm every 5 mm, or 1 cm every 1 cm) in patients scheduled to undergo elective abdominal surgery by midline laparotomy. The distance between the rectus abdominis muscles (RAM distance) was measured by standardized ultrasound imaging 1 month and 1 year after surgery. The relationship between the 1‐year incidence of incisional hernia and the RAM distance at 1 month was investigated.ResultsSome 219 patients were investigated, 113 in the small‐bites and 106 in the large‐bites group. At 1 month after surgery the RAM distance was smaller for small bites than for large bites (mean(s.d.) 1·90(1·18) versus 2·39(1·34) cm respectively; P = 0·005). At 1 year, patients with incisional hernia had a longer RAM distance at 1 month than those with no incisional hernia (mean(s.d.) 2·43(1·48) versus 2·03(1·19) cm respectively; relative risk 1·14, 95 per cent c.i. 1·03 to 1·26, P = 0·015).ConclusionA RAM distance greater than 2 cm at 1 month after midline laparotomy is associated with incisional hernia. Closure with small bites results in a smaller distance between the muscles.