A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer.
ABSTRACT To address the incidence of deep wound dehiscence and incisional hernia formation with two types of mass closure after vertical midline laparotomy performed in patients with gynecologic cancer.
Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. Of the 614 subjects who could be evaluated, 308 underwent a continuous, non-locking closure with looped polyglyconate suture, and 306 were closed with interrupted polyglycolic acid according to the Smead-Jones technique.
Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infection (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follow-up period was 6 months to 3 years. No patient had evidence of chronic sinus drainage. Thirty-two (10.4%) of the patients who had the continuous closure and 45 (14.7%) of those who were closed with the interrupted method had evidence of incisional hernia (P = .14). No hernia developed in any patient with a wound infection. Four (1.3%) hernias after the continuous closure and eight (2.6%) after the interrupted closure required surgical repair because of patient discomfort (P = .38).
The interrupted closure was not superior to the continuous closure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster.
- SourceAvailable from: scielo.brABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 03/2008; 21(1):21-24.
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ABSTRACT: Integrated power and desalination plants (IPDP) may provide a key solution for the pressing freshwater deficit and energy problems in many regions of the world. The current study investigates the potential of low-temperature multi-effect distillation (LT-MED) and thermal vapor compression multi-effect distillation (TVC-MED) coupled with a concentrating solar power (CSP) plant, taking also into account a reverse osmosis (RO) unit connected to the same power plant. The thermodynamic performance of the proposed schemes of IPDP has been evaluated by the assessment of the net output thermal capacity and the net power cycle efficiency of the different configurations, together with the estimation of the size of the solar field required to provide the corresponding thermal capacity. The results show that the combination with LT-MED is more efficient thermodynamically than with TVC-MED. Also, the CSP plant coupled with TVC-MED is more cost-effective than the independent processes because it requires a smaller solar field. The integration of a MED plant reduces the cooling requirements of a CSP power plant but the CSP+RO combination has a better thermodynamic efficiency. However, the difference with respect to CSP+LT-MED is small, so the latter can be more convenient in some cases.Desalination 10/2011; 281:379-387. · 3.96 Impact Factor
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ABSTRACT: Objective Ventral incisional hernia is a common complication of abdominal surgery. The incidence ranges from 2% to 20% and varies greatly from one series to another. The goal of this study was to determine the incidence, risk factors, and preventive measures for ventral incisional hernia. Materials and methods An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia and hernia prevention. Results The overall incidence of incisional hernia after laparotomy was 9.9%. The incidence was significantly higher for midline incisions compared with transverse incisions (11% versus 4.7%; P = 0.006). In contrast, the incidence of ventral hernia was only 0.7% after laparoscopy. A compilation of all the studies comparing laparotomy to laparoscopy showed a significantly higher incidence of incisional hernia after laparotomy (P = 0.001). Independent risk factors for incisional hernia included age and infectious complications. Only two meta-analyses were able to show a significant decrease in risk-related to the use of non-absorbable or slowly absorbable suture material. No difference in incisional hernia risk was shown with different suture techniques (11.1% for running suture, 9.8% for interrupted sutures: NS). Conclusion A review of the literature shows that only the choice of incisional approach (transverse incision or laparotomy versus midline laparotomy) allows a significant decrease in the incidence of ventral incisional hernia.Journal de Chirurgie Viscérale. 10/2012; 149(5):S3–S15.