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Erschienen in: World Journal of Surgery 9/2016

08.07.2016 | Original Scientific Report

Mass Continuous Suture versus Layered Interrupted Suture in Transverse Abdominal Incision Closure after Liver Resection

verfasst von: Jing Zhang, Hong-Ke Zhang, Hao-Yang Zhu, Jian-Wen Lu, Qiang Lu, Yi-Fan Ren, Chang Liu, Jian Dong, Zhao-Qing Du, Xue-Min Liu, Zheng Wu, Yi Lv, Xu-Feng Zhang

Erschienen in: World Journal of Surgery | Ausgabe 9/2016

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Abstract

Background

Abdominal incision closure technique seriously influences patient prognosis. Most studies have focused on the different suture techniques and materials on midline incision, while little data are available in wide transverse or oblique incisions after liver resection (LR). The aim of the present study is to compare the two major incision suture methods after LR in our institute: Mass continuous suture (group P) and layered interrupted suture (group S).

Study design

258 patients undergoing LR with abdominal transverse or oblique incisions were prospectively enrolled. They were divided into two groups according to different abdominal incision suture methods and compared with the preoperative, intraoperative parameters, and postoperative wound complications.

Results

There were 118 patients in group P and 140 patients in group S, which was similar in general condition, primary disease, liver, and renal function. Incision length, total operation time, intraoperative blood loss, or perioperative antibiotics use were not different between the two groups. However, abdominal incision closure time and interval time for stitches removing after operation was significantly shorter in group P than group S (both p < 0.001). After a median follow-up of 16 months, the incidence of wound infection and fat liquefaction was more than two times higher in group S than group P, which, however, was not statistically different. Moreover, there was no difference in wound disruption or incisional hernia between the two groups.

Conclusions

Although similar in occurrence of postoperative wound complications, mass continuous suture with polydioxanone seemed to be more timesaving in incision closure and motivated in wound healing.
Literatur
1.
Zurück zum Zitat Fortelny RH, Baumann P, Thasler WE et al (2015) Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial. Trials 16:52CrossRefPubMedPubMedCentral Fortelny RH, Baumann P, Thasler WE et al (2015) Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial. Trials 16:52CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Richards PC, Balch CM, Aldrete JS (1983) Abdominal wound closure—a randomized prospective-study of 571 patients comparing continuous vs interrupted suture techniques. Ann Surg 197:238–243CrossRefPubMedPubMedCentral Richards PC, Balch CM, Aldrete JS (1983) Abdominal wound closure—a randomized prospective-study of 571 patients comparing continuous vs interrupted suture techniques. Ann Surg 197:238–243CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Israelsson LA, Jonsson T (1997) Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 163:175–180PubMed Israelsson LA, Jonsson T (1997) Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 163:175–180PubMed
4.
Zurück zum Zitat Ceydeli A, Rucinski J, Wise L (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62:220–225CrossRefPubMed Ceydeli A, Rucinski J, Wise L (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62:220–225CrossRefPubMed
5.
Zurück zum Zitat Bickenbach KA, Karanicolas PJ, Ammori JB et al (2013) Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg 206:400–409CrossRefPubMed Bickenbach KA, Karanicolas PJ, Ammori JB et al (2013) Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg 206:400–409CrossRefPubMed
6.
Zurück zum Zitat Brown SR, Goodfellow PB (2005) Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev:CD005199 Brown SR, Goodfellow PB (2005) Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev:CD005199
7.
Zurück zum Zitat Diener MK, Voss S, Jensen K et al (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251:843–856CrossRefPubMed Diener MK, Voss S, Jensen K et al (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251:843–856CrossRefPubMed
8.
Zurück zum Zitat van ‘t Riet M, Steyerberg EW, Nellensteyn J et al (2002) Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 89:1350–1356CrossRefPubMed van ‘t Riet M, Steyerberg EW, Nellensteyn J et al (2002) Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 89:1350–1356CrossRefPubMed
9.
Zurück zum Zitat Muysoms FE, Antoniou SA, Bury K et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24CrossRefPubMed Muysoms FE, Antoniou SA, Bury K et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24CrossRefPubMed
10.
Zurück zum Zitat Togo S, Nagano Y, Masumoto C et al (2008) Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 12:1115–1120CrossRefPubMed Togo S, Nagano Y, Masumoto C et al (2008) Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 12:1115–1120CrossRefPubMed
11.
Zurück zum Zitat D’Angelica M, Maddineni S, Fong Y et al (2006) Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg 30:410–418. doi:10.1007/s00268-005-0183-x CrossRefPubMed D’Angelica M, Maddineni S, Fong Y et al (2006) Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg 30:410–418. doi:10.​1007/​s00268-005-0183-x CrossRefPubMed
12.
Zurück zum Zitat Kayashima H, Maeda T, Harada N et al (2015) Risk factors for incisional hernia after hepatic resection for hepatocellular carcinoma in patients with liver cirrhosis. Surgery 158:1669–1675CrossRefPubMed Kayashima H, Maeda T, Harada N et al (2015) Risk factors for incisional hernia after hepatic resection for hepatocellular carcinoma in patients with liver cirrhosis. Surgery 158:1669–1675CrossRefPubMed
13.
Zurück zum Zitat Niggebrugge AH, Trimbos JB, Hermans J et al (1999) Influence of abdominal-wound closure technique on complications after surgery: a randomised study. Lancet 353:1563–1567CrossRefPubMed Niggebrugge AH, Trimbos JB, Hermans J et al (1999) Influence of abdominal-wound closure technique on complications after surgery: a randomised study. Lancet 353:1563–1567CrossRefPubMed
14.
Zurück zum Zitat Weiland DE, Bay RC, Del Sordi S (1998) Choosing the best abdominal closure by meta-analysis. Am J Surg 176:666–670CrossRefPubMed Weiland DE, Bay RC, Del Sordi S (1998) Choosing the best abdominal closure by meta-analysis. Am J Surg 176:666–670CrossRefPubMed
15.
Zurück zum Zitat Carlson DC, Wornom IL 3rd, Aldrete JS (1984) Abdominal wound closure. Ala J Med Sci 21:49–53PubMed Carlson DC, Wornom IL 3rd, Aldrete JS (1984) Abdominal wound closure. Ala J Med Sci 21:49–53PubMed
16.
Zurück zum Zitat Agrawal CS, Tiwari P, Mishra S et al (2014) Interrupted abdominal closure prevents burst: randomized controlled trial comparing interrupted-x and conventional continuous closures in surgical and gynecological patients. Indian J Surg 76:270–276PubMed Agrawal CS, Tiwari P, Mishra S et al (2014) Interrupted abdominal closure prevents burst: randomized controlled trial comparing interrupted-x and conventional continuous closures in surgical and gynecological patients. Indian J Surg 76:270–276PubMed
17.
Zurück zum Zitat Smart P, Mann GB (2003) Meta-analysis of techniques for closure of midline abdominal incisions (Br J Surg 2002;89:1350–1356). Br J Surg 90:370CrossRefPubMed Smart P, Mann GB (2003) Meta-analysis of techniques for closure of midline abdominal incisions (Br J Surg 2002;89:1350–1356). Br J Surg 90:370CrossRefPubMed
18.
Zurück zum Zitat Rink AD, Goldschmidt D, Dietrich J et al (2000) Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study. Eur J Surg 166:932–937CrossRefPubMed Rink AD, Goldschmidt D, Dietrich J et al (2000) Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study. Eur J Surg 166:932–937CrossRefPubMed
19.
Zurück zum Zitat Seiler CM, Bruckner T, Diener MK et al (2009) Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 249:576–582CrossRefPubMed Seiler CM, Bruckner T, Diener MK et al (2009) Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 249:576–582CrossRefPubMed
20.
Zurück zum Zitat Fujita T (2009) Suture materials and techniques for midline abdominal closure. Ann Surg 250:656 (author reply 656–657) CrossRefPubMed Fujita T (2009) Suture materials and techniques for midline abdominal closure. Ann Surg 250:656 (author reply 656–657) CrossRefPubMed
21.
Zurück zum Zitat Hugh TB, Nankivell C, Meagher AP et al (1990) Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? World J Surg 14:231–233. doi:10.1007/BF01664878 (discussion 233–4) CrossRefPubMed Hugh TB, Nankivell C, Meagher AP et al (1990) Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? World J Surg 14:231–233. doi:10.​1007/​BF01664878 (discussion 233–4) CrossRefPubMed
22.
Zurück zum Zitat Dudley HA (1970) Layered and mass closure of the abdominal wall. A theoretical and experimental analysis. Br J Surg 57:664–667CrossRefPubMed Dudley HA (1970) Layered and mass closure of the abdominal wall. A theoretical and experimental analysis. Br J Surg 57:664–667CrossRefPubMed
23.
Zurück zum Zitat Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 284:931–933CrossRef Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 284:931–933CrossRef
24.
Zurück zum Zitat Martyak SN, Curtis LE (1976) Abdominal incision and closure. A systems approach. Am J Surg 131:476–480CrossRefPubMed Martyak SN, Curtis LE (1976) Abdominal incision and closure. A systems approach. Am J Surg 131:476–480CrossRefPubMed
25.
Zurück zum Zitat Rucinski J, Margolis M, Panagopoulos G et al (2001) Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg 67:421–426PubMed Rucinski J, Margolis M, Panagopoulos G et al (2001) Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg 67:421–426PubMed
26.
27.
Zurück zum Zitat Schoetz DJ Jr, Coller JA, Veidenheimer MC (1988) Closure of abdominal wounds with polydioxanone. A prospective study. Arch Surg 123:72–74CrossRefPubMed Schoetz DJ Jr, Coller JA, Veidenheimer MC (1988) Closure of abdominal wounds with polydioxanone. A prospective study. Arch Surg 123:72–74CrossRefPubMed
28.
Zurück zum Zitat Corman ML, Veidenheimer MC, Coller JA (1981) Controlled clinical trial of three suture materials for abdominal wall closure after bowl operations. Am J Surg 141:510–513CrossRefPubMed Corman ML, Veidenheimer MC, Coller JA (1981) Controlled clinical trial of three suture materials for abdominal wall closure after bowl operations. Am J Surg 141:510–513CrossRefPubMed
29.
Zurück zum Zitat Gys T, Hubens A (1989) A prospective comparative clinical study between monofilament absorbable and non-absorbable sutures for abdominal wall closure. Acta Chir Belg 89:265–270PubMed Gys T, Hubens A (1989) A prospective comparative clinical study between monofilament absorbable and non-absorbable sutures for abdominal wall closure. Acta Chir Belg 89:265–270PubMed
30.
Zurück zum Zitat Carlson MA, Condon RE (1995) Polyglyconate (Maxon) versus nylon suture in midline abdominal incision closure: a prospective randomized trial. Am Surg 61:980–983PubMed Carlson MA, Condon RE (1995) Polyglyconate (Maxon) versus nylon suture in midline abdominal incision closure: a prospective randomized trial. Am Surg 61:980–983PubMed
31.
Zurück zum Zitat Cameron AE, Parker CJ, Field ES et al (1987) A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure. Ann R Coll Surg Engl 69:113–115PubMedPubMedCentral Cameron AE, Parker CJ, Field ES et al (1987) A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure. Ann R Coll Surg Engl 69:113–115PubMedPubMedCentral
32.
Zurück zum Zitat Sajid MS, Parampalli U, Baig MK et al (2011) A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg 9:615–625CrossRefPubMed Sajid MS, Parampalli U, Baig MK et al (2011) A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg 9:615–625CrossRefPubMed
Metadaten
Titel
Mass Continuous Suture versus Layered Interrupted Suture in Transverse Abdominal Incision Closure after Liver Resection
verfasst von
Jing Zhang
Hong-Ke Zhang
Hao-Yang Zhu
Jian-Wen Lu
Qiang Lu
Yi-Fan Ren
Chang Liu
Jian Dong
Zhao-Qing Du
Xue-Min Liu
Zheng Wu
Yi Lv
Xu-Feng Zhang
Publikationsdatum
08.07.2016
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 9/2016
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3617-8

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