Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials

Abstract

Objectives: A systematic review was undertaken to evaluate the effectiveness of incision retention available to surgeons conducting open abdominal or pelvic surgeries. Both the ability of the retractor to retain the wound and harm to the patient due to the retractor were reviewed. Methods: A search was conducted using the following databases: EMBASE, PubMed, BIOSIS, Engineering Village, Web of Science, Best practice, Science Direct, CRCnet BASE, Proquest, Wiley Online Library, and Comprehensive Biomaterial. Results: What the articles found were then narrowed down to those which matched the objective of the review. This resulted in ten articles to review. Two reviewers reviewed and summarized the articles. Femoral neuropathy was found to be a common complication due to Retractors. Other outcomes analysed or studied were found to be infected, postoperative pain and exposure provided. Femoral neuropathy can be estimated to occur at a rate between 2.6% and 7.5% in open pelvic and abdominal surgeries. The Alexis O-ring retractor was found to lower the required morphine intake following surgery when compared to the Belfour retractor. Conclusions: There is a lack of high quality/high levels of evidence studies that have been conducted on Retractors. Femoral neuropathy is the outcome most commonly documented in relation to Retractors. Surgeons need to be aware about the use and implementations of the retractors. Care should be taken in protecting the blades and during long surgery relocating retractors should be considered.

Novel surgical integration technique in ravitch procedure using an atraumatic o-ring wound retractor: case report

“…We could switch intravenous analgesia to oral intake without the need of opioids with good pain control; this outcome may be attributed by thoracic epidural anesthesia. However we think that the O-ring wound retractor also contributed in pain control, supporting us with Lohsiriwat and Chowdary findings in which they concluded reduction in early postoperative pain and a significant reduction in the amount of intravenous analgesia with the use of an O-ring wound retractor in abdominal surgery [3,6]. The patient was discharged home when the pain was well controlled with oral pain medications (3 days).…”

“…Lohsiriwat in 2014 identified soft tissue damage as a comorbid factor that intensifies post-operative pain and cause cicatrisation outcome alteration [3,4]. In 2012 Cheng and Biewenga reported that atraumatic O-ring retractor is a modern self-retaining wound retractor which provides circumferential retraction that causes less tissue damage, thus reducing pain following open surgeries than conventional auto self-retractors [4][5][6]. Modified Ravitch procedure has been associated to soft tissue complications due extensive dissection and prolonged intravenous analgesia administration for pain management [1,2].…”