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: Background: Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. It's prevention is important to reduce post operative morbidity and mortality Research Hypothesis: The application of interrupted X-sutures reduces the risk of burst in midline laparotomy wounds. Aims: To compare the risks of burst with continuous versus interrupted suturing in midline laparotomy wounds. Setting: Surgical Wards of All India Institute of Medical Sciences (AIIMS), a tertiary care center. Design: Open randomised trial with two arms. Material and Methods: One hundred patients undergoing emergency laparotomy and 110 patients undergoing elective laparotomy through a midline vertical incision were randomized after informed consent, to either a continuous closure or an interrupted X technique. Main Outcome Variable: The risk of burst abdomen diagnosed by a consultant. Predictor Variables: intraperitoneal sepsis, abdominal distension, cough, diabetes, malignancy, anaemia, hypoxia, uraemia, hypoalbuminaemia. Statistical Analysis: The risk of burst in each group and relative risk (RR) of burst (using continuous group as the reference category) were caluculated. Results: There were one burst (out of 46) in the X suture group and 8 bursts (out of 54) in the continuous arm in the emergency group. The RR for burst (continuous group as the reference category) was 0.15 (95% C.I. : 0.02 to 1.13, P=0.028). Conclusion: The risk of burst in the emergency group is less with interrupted X method of closure. Sepsis, cough, anaemia, malnutrition and abdominal distension are significant risk factors for burst.
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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