[Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients]. / Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo.

INTRODUCTION: The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. MATERIAL AND METHODS: We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. RESULTS: A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. CONCLUSIONS: Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility.

Risk factors for nonhepatic surgery in patients with cirrhosis.

Cirrhosis of the liver appears to have an unfavorable prognosis in the surgical patient. The aim of this study was to determine risk factors for morbidity and mortality in patients with cirrhosis undergoing nonhepatic surgery. We studied 135 patients with liver cirrhosis undergoing nonhepatic procedures and 86 controls matched by age, sex, and preoperative diagnosis. Preoperative, intraoperative, and postoperative variables associated with 30-day mortality and morbidity were assessed by univariate and multivariate analyses. Patients with cirrhosis showed higher blood transfusion requirements, longer length of hospital stay, and a higher number of complications than controls. The mortality rate was 16.3% in cirrhotics and 3.5% in controls. By univariate analysis, the need for transfusions, prothrombin time, and Child-Pugh score were significantly associated with postoperative liver decompensation, whereas duration of surgery, prothrombin time, Child-Pugh score, cirrhosis-related complications, and general complications were significantly associated with mortality. In the multivariate analysis, Child-Pugh score (odds ratio [OR] 24.4; 95% confidence interval [CI] 5.5 to 106); duration of surgery (OR 5; 95% CI 1.2 to 15.6), and postoperative general complications (OR 3.7; 95% CI 3.4 to 6.4) were independent predictors of mortality. Patients with cirrhosis undergoing nonhepatic operations are at significant risk of perioperative complications leading to death. Independent variables associated with perioperative mortality include preoperative Child-Pugh score, the duration of surgery, and the presence of postoperative general complications.

Estudio clínico aleatorizado entre sutura de polidioxanona y de naylon en el cierre de laparotomía en pacientes de riesgo / Randomized clinical study of polydioxanone and nylon sutures for laparotomy clousure in high-risk patients

Introducción. Las complicaciones del cierre de la herida quirúrgica en enfermos con factores de riesgo aumentan significativamente su morbimortalidad. El objeto del estudio es valorar la presencia de diferencias en el cierre de la pared abdominal en pacientes con criterios de riesgo, con la misma técnica de cierre entre sutura de reabsorción lenta y sutura no absorbible. Material y métodos. Estudio prospectivo multicéntrico, comparativo entre polidioxanona y nailon. Se incluyen laparotomías por enfermedad intestinal y hepatobiliopancreática, con un factor de riesgo añadido. Se excluyen eventraciones, intervención por obesidad, cierre con puntos totales, incisiones de escasa incidencia, pronóstico vital menor de 1,5 años o fallecimiento sin relación con la herida. El cierre fue con sutura continua en bloque con lazo, monoplano extracutánea. Se evalúa la infección, la evisceración, la dehiscencia, la extrusión, el sinus, la eventración, la intolerancia y el dolor. Controles: postoperatorio, 10 y 30 días, 3 y 6 meses, 1 año y 1,5 años. Resultados. Se incluyó a 770 pacientes, 451 en el grupo de polidioxanona y 319 en el grupo de nailon El 78,05% eran incisiones medias, con 23,3 cm de longitud media. El calibre de la sutura más utilizado era de 1 (85,45%). Se utilizaron 1,7 suturas por paciente. En el 94,03% no hubo complicaciones, y se obtuvieron los mismos resultados en ambos grupos (94,7% en la polidioxanona y el 93,1% en el nailon). En controles posteriores, los resultados fueron similares a lo largo del tiempo. La tasa de infección quirúrgica fue del 10%. No hay diferencias en ninguno de los controles para ninguna de las variables analizadas. Conclusiones. El cierre de la pared abdominal debería realizarse con sutura continua de material de absorción lenta, como la polidiaxonona, al presentar una incidencia similar de complicaciones y una mayor biocompatibilidad que las suturas irreabsorbibles (AU)

Introduction. The complications of surgical wound closure in patients with risk factors significantly increases morbidity and mortality. The aim of the present study was to evaluate differences in abdominal wall closure in patients with risk factors with the same closure technique and slow-absorbable or non-absorbable sutures. Material and methods. We performed a prospective, multicenter, comparative study of polydioxanone versus nylon sutures. Laparotomies performed for intestinal diseases and hepatobiliopancreatic procedures in patients with at least one risk factor were included. Exclusions criteria were eventrations, interventions for obesity, the need for reinforcement sutures, uncommon incisions, life expectancy of less than 1.5 years and deaths unrelated to the wound. Closure was performed with monoplane, extracutaneous, continuous, en bloc, loop sutures. Infection, evisceration, dehiscence, extrusion, sinus, eventration, intolerance, and pain were evaluated. Postoperative follow-up was performed at 10 and 30 days, 3 and 6 months, and at 1 and 1.5 years. Results. A total of 770 patients were included (451 in the polydioxanone group and 319 in the nylon group). A total of 78.05% were midline incisions, with a mean length of 23.3 cm. Caliber 1 sutures were most frequently used (85.45%), and 1.7 sutures were used per patient. No complications occurred in 94.03% with no differences between groups (94.7% polydioxanone and 93.1% nylon). The results were similar throughout follow-up. The surgical infection rate was 10%. No differences were found in any of the follow-up assessments in any of the variables analyzed. Conclusions. Abdominal wall closure should be performed with continuous slow-absorption sutures such as polydioxanone since this type of suture has a similar complication rate to reabsorbable sutures and presents greater biocompatibility (AU)