Post-laparotomy wound healing complication – what matters more: surgical technique or patient’s condition? : Poland Post-laparotomy wound healing complication – what matters more: surgical technique or patient’s condition? S. Dąbrowiecki, S. Pierściński, A. Kapała, S. Prywiński, W. Szczęsny, W. Gniłka, J. Pypkowski, J. Szopiński, D. Sosnowski, J. Szmytkowski, P. Wierzchowski, J. Andruszkiewicz Dept. of General & Endocrine Surgery, NCU, Coll. Medicum, Bydgoszcz, Poland
Slide 2 : OR What matters more? vertical midline incision, 12 ms FU 5% - 15% incisional hernias (= 50% whole hernias) burst abdomen up to 3%; mortality rate > 25%
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Research design : Research design FU of the patients with the elevated risk of the complications in laparotomy wound healing
Standardized technique of laparotomy wound closure
Endpoints:
Primary: wound dehiscence, incisional hernia
Secondary: infection, edema, erythema, seroma, suture sinus, and pain
FU: examination at the outpatient department was scheduled at 1, 3, and at least at 12 ms after the surgery
Inclusion criteria : Inclusion criteria age > 65 y
BMI > 30
neoplasmatic disease (life expectancy >1 y)
hipoalbuminemia <3,4 g/L
ascites
hypercortisolemia
any condition deteriorating wound healing re-laparotomy
wound contaminated during the surgery and dirty wound
surgery time > 2,5 h anemia < 10g%
sepsis with abdominal origin
pneumonia or COPD
hemodynamic instability combined indications
Surgical technique : Surgical technique
Surgical technique : A B C Surgical technique obligatory: mass closure, running suture, monofilament, PDS 2-0
not mandatory technique but values registered: wound length, suture length, number of loops
additionally calculated variables : SL/WL, loops distance, width of sutured fasciae
Patients n=185 : Patients n=185
Patients : Patients Indication to surgery
32 diseases; the most frequent:
42 ca colonis
41 morbid obesity
33 different path. of biliary tract
19 dig. tract perforation
7 ca ventriculi
6 abdominal trauma
Possum scale 13.6 (6-37) points
Hospital stay 12.5 (2-79) days mean (range)
Evaluation : Evaluation P-ts lost to FU
following 1 ms – 8 pts
3 ms – 17 pts
12 ms – 27 pts
Statistical analysis:
Kaplan & Meier product-limit method comparing two and multiple samples
Cox's Proportional Hazard Model
Mann-Whitney U Test
Slide 12 : A B C Laparotomy closure technique
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Results : Results Age 54 vs 64 y
Gender
ASA
Elective vs urgent treatment
Possum scale
BMI vs NEO vs other NS NS NS p<0.05 p<0.05 NS
laparotomy location contamination class : laparotomy location contamination class p<0.05 p<0.05
wound length suture length number of suture loops SL/WL SL/one suture loop suture distance width of fascia margin wound drainage single vs running skin suture : wound length suture lengthnumber of suture loopsSL/WL SL/one suture loopsuture distancewidth of fascia marginwound drainage single vs running skin suture NS NS NS NS NS NS NS NS NS
The course of skin wound healing : The course of skin wound healing p<0.05 p<0.05
Which risk factors matter more : Which risk factors matter more NS
The incidence of a dehiscence or incisional hernia : The incidence of a dehiscence or incisional hernia Related to:
patients’ age, disease,
wound contamination, wound healing Not related to:
laparotomy closure technique laparotomy location
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Intra-op contamination vs hernia : Intra-op contamination vs hernia