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.
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ABSTRACT: Aim: to evaluate the effectiveness of supporting plastic tubes technique (new technique) in prophylaxis against burst abdomen. Methods: a total of 140 patients, 76 patients underwent emergency laparotomy and 64 underwent elective laparotomy through midline laparotomy through a midline vertical incision. They were randomized to either mass closure alone or mass closure plus supporting plastic tube technique. All patients were consented. Results: There were 3 bursts out of 70 patients in the mass closure alone group (4.28% risk). while none of the patients in the supporting tubes group underwent burst (0% risk).However, there were two cases in the later group developed incisional hernia in the late post-operative period. Conclusion: supporting plastic tubes method is a good prophylactic method against burst abdomen, not for incisional hernia, and it is advised to be used in all risky patients.
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ABSTRACT: We performed a retrospective study of patients with evisceration treated in the previous 9 years. Among 3276 patients with gynecologic diseases who underwent laparotomy, 13 eviscerations were detected. The mean age was 66 years. Diagnosis was gynecologic cancer in nine patients. Emergency surgery was performed in two patients. The main clinical finding was staining of the dressing. The mean length of hospital stay was 27 days. One patient died as a result of the evisceration. The most frequent risk factors in our series were age greater than 65 years, gynecologic cancer, exogenous obesity, and diabetes. Because these risk factors can be predicted, when several are grouped together, reinforcement should be used when closing the abdominal wall.Clínica e Investigación en Ginecología y Obstetricia 03/2010; 37(2). DOI:10.1016/j.gine.2009.03.007
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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.10/2012; 149(5):S3–S15. DOI:10.1016/j.jchirv.2012.03.011