A Randomized Clinical Trial Comparing Two Methods of Fascia Closure Following Midline Laparotomy

Trimbos, J. B.; Šmit, Iva; Holm, Jozien P.; Hermans, John J.

doi:10.1001/archsurg.1992.01420100094016

Cited by 90 publications

(38 citation statements)

References 12 publications

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“…However, since the introduction of synthetic absorbable sutures, the majority of these trials have shown no difference in the overall incidence of wound complications in comparison with various nonabsorbable sutures. At least four studies [9, 67, 68, 69]compared continuous versus interrupted closure of midline incisions. All found that continuous suture closure was as effective and as safe as interrupted suture closure with the advantage of being more expeditious.…”

Section: Wound-related Factorsmentioning

confidence: 99%

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Incisional Hernias

Yahchouchy-Chouillard

Aura²,

Picone³

et al. 2003

Dig Surg

158

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Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors review the literature emphasizing the current knowledge concerning the pathogenesis of incisional hernias. The second article is focused on the treatment.

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Section: Wound-related Factorsmentioning

confidence: 99%

“…However, PDS seems to be associated with a lower rate of IH [69, 70]. The double-stranded suture type providing nearly twice the initial tensile strength of a single strand of the same diameter may be valuable in high-risk patients (i.e., those having obesity) [70].…”

Section: Wound-related Factorsmentioning

confidence: 99%

Incisional Hernias

Yahchouchy-Chouillard

Aura²,

Picone³

et al. 2003

Dig Surg

158

View full text Add to dashboard Cite

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“…These are also mechanic factors affecting wound healing. Wound infections of varying degrees affect the abdominal wall at different rates and they are major causes of development of incisional hernia or wound dehiscence (14,24,25). In our series, wound infection that was present in 69 patients (26%), had a significant relationship with incisional hernia (p=0.011) and wound dehiscence (p=0.001).…”

Section: Discussionmentioning

confidence: 57%

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Yılmaz

Akıncı

Doğan

et al. 2013

UCD

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Objective: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. Material and Methods:The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis.Results: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Conclusion:Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.Key Words: Abdominal surgery, wound dehiscence, incisional hernia, sinus formation, chronic incisional pain INTRODUCTIONWound dehiscence after laparotomy can manifest with different presentations varying from simple skin detachment to evisceration and eventration, leading to an increase in surgical mortality and morbidity, as well as increase in length of hospital stay and loss of work force.Anterior abdominal wall incision hernia that can be seen in the long term is also one of the common surgical complications. Known as postoperative hernia or incisional hernia, it is thought to result from insufficient closure of the fascia and/or poor healing. Factors causing chronic or prolonged postoperative intra-abdominal pressure increase and those affecting wound healing contribute to its development. The incidence of incisional hernias vary from 2% to 20% in different sources, and in addition to pain and impairment in quality of life it may also cause significant complications (1, 2). It has been reported that incarceration may occur in a rate of 15%, ...

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“…They recommended that closing midline abdominal fascial wounds with a running suture may be a superior method of closure in clean, incised wounds. Trimbos JB et al 13 in 1992 found that continuous closure of laparotomy wound was faster. They concluded that a running polyglyconate suture was better choice for closure of abdominal wall following midline laparotomy.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Single Layer Closure and Conventional Layered Closure of Laparotomy Wounds

Sreeharsha¹

2013

jemds

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HOW TO CITE THIS ARTICLE:Sreeharsha ABSTRACT: OBJECTIVE:To compare the techniques of single layer closure and conventional layered closure of laparotomy wounds on the basis of operative time and post-operative complications. METHODS: Prospective randomized study of 100 patients who underwent laparotomy in a tertiary care hospital in Karnataka, for abdominal surgical problems needing either emergency or elective surgery. Out of these 100 patients, 50 patients underwent laparotomy wound closure by single layer closure technique and the rest 50 patients by conventional layered closure technique. Time taken for closure of laparotomy wound was noted and patients were followed up post-operatively for any wound complications like seroma, wound infection, wound gaping, burst abdomen and incisional hernia. RESULTS: The mean time taken for closure of laparotomy wounds by single layer closure technique was 19 minutes and by conventional layered closure technique was 27 minutes. There was a difference of 8 minutes which was statistically significant (p=0.001). In the postoperative period, in patients who underwent single layer closure, totally 9 patients (18%) had post operative complications. In that 3 patients (6%) had seroma, 3 patients (6%) had wound infection, 2 patients (4%) had wound gaping, 1 patient (2%) had burst abdomen and none had incisional hernia. In patients who underwent conventional layered closure, totally 15 patients (30%) had post operative complications. In that 5 patients (10%) had seroma, 4 patients (8%) had wound infection, 3 patients (6%) had wound gaping, 2 patients (4%) had burst abdomen and 1 patient (2%) had incisional hernia. CONCLUSION: Laparotomy wound closure with single layer closure technique is better than the conventional layered closure technique in terms of decreased operative time and also decreased postoperative complications.

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A Randomized Clinical Trial Comparing Two Methods of Fascia Closure Following Midline Laparotomy

Cited by 90 publications

References 12 publications

Incisional Hernias

Incisional Hernias

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

A Comparative Study of Single Layer Closure and Conventional Layered Closure of Laparotomy Wounds

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