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2.
Isr Med Assoc J ; 22(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927805

RESUMEN

BACKGROUND: Temporary abdominal closure (TAC) surgical technique relates to a procedure in which the post-surgical abdominal wall remains open in certain indications. The Bogota bag (BB) technique is a tension-free TAC method that covers the abdominal contents with a sterilized fluid bag. There are very few reports of pediatric patients treated with this technique. OBJECTIVES: To describe our institution's 15 years of experience using the BB technique on pediatric patients. METHODS: A retrospective cohort study describing our experience treating patients with BB was conducted. The medical files of 17 pediatric patients aged 0-18 years were reviewed. RESULTS: Between January 2000 and December 2014, 17 patients were treated with BB at our medical center (6 females, median age 12 years). Indications for BB were a need for a surgical site re-exploration, mechanical inability for primary abdominal closure, and high risk for ACS development. Median BB duration was 5 days and median bag replacement was 2 days. Median ICU length of stay (LOS) was 10 days and hospital LOS was 27 days. The ICU admission and BB procedure was tolerated well by 6 patients who were discharged home without complications. Of the remaining 11 patients, 6 patients died during the admission (35%) and the others presented with major complications not related to the BB but to the patient's primary disease. CONCLUSIONS: This report represents the largest series of children treated with BB. The technique is simple to perform, inexpensive, and has very few complications.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Abdomen/cirugía , Pared Abdominal/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
3.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-31994498

RESUMEN

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Asunto(s)
Técnicas de Cierre de Herida Abdominal/educación , Aponeurosis/cirugía , Hernia Ventral/prevención & control , Hernia Incisional/prevención & control , Laparotomía/efectos adversos , Técnicas de Sutura/educación , Fascia , Hernia Ventral/etiología , Humanos , Hernia Incisional/etiología , Laparotomía/educación , Modelos Anatómicos
4.
Am Surg ; 85(10): 1139-1141, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657310

RESUMEN

Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender (P = 0.03) and base deficit were associated (P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs (P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.


Asunto(s)
Traumatismos Abdominales/cirugía , Técnicas de Cierre de Herida Abdominal/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Herida Quirúrgica/cirugía , Técnicas de Cierre de Herida Abdominal/estadística & datos numéricos , Adulto , Profilaxis Antibiótica/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/métodos , Duodeno/lesiones , Femenino , Humanos , Intestino Delgado/lesiones , Yeyuno/lesiones , Masculino , Estudios Retrospectivos , Piel , Estadísticas no Paramétricas , Estómago/lesiones , Infección de la Herida Quirúrgica/clasificación , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control
5.
Surg Technol Int ; 35: 17-26, 2019 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-31476791

RESUMEN

Due to its decreased recovery time and increased patient satisfaction, laparoscopic surgery has witnessed an exponential rise in the last decade. In fact, the indications for laparoscopic surgery are currently numerous and involve multiple disciplines, including gastro-intestinal and gynecological surgery. With this boom, there is much focus on decreasing the rate of complications due to laparoscopy. This includes, but is not limited to, an increased interest in decreasing the risk of port-site herniation by ensuring proper closure of the abdominal wall at the site of port-insertion.


Asunto(s)
Pared Abdominal , Técnicas de Cierre de Herida Abdominal , Laparoscopía , Fascia , Femenino , Procedimientos Quirúrgicos Ginecológicos , Humanos , Laparoscopía/métodos
6.
Medicine (Baltimore) ; 98(35): e16617, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31464898

RESUMEN

It is unclear whether strategies targeting negative fluid balance are associated with facilitated early fascial closure. The present study investigated the effects of fluid removal therapy on early facial closure of open abdomen patients.A prospective study was conducted in patients who underwent open abdomen management with vacuum-assisted and mesh-mediated fascial traction technique. Therapeutic diuresis with torasemide was applied to cause negative fluid balance in the treatment group. The study and follow-up periods were 7 and 180 days, respectively. The observational indices included the intra-abdominal pressure, the number of days to closure, the type of closure, the septic complications, the duration of ventilation support, the duration of initial hospital stay, and the duration of intensive care unit (ICU) stay.A total of 27 patients were divided into the treatment (16 patients) and control (11 patients) groups. The median intra-abdominal pressure (IAP) of the patients of the control and the treatment groups was significantly lower at day 7 compared with the baseline value (P < .0001). IAP was lower in the treatment group compared with that noted in the control group, following day 4 of the fluid removal therapy (P < .05). The percentage weight loss in the treatment group was between 4.80% and 10.88%. The early closure rates were significantly higher in the treatment group compared with those in the control group (75.0% vs 18.2%, P = .0063).Fluid removal therapy combined with vacuum-assisted and mesh-mediated fascial traction provided a high early fascial closure rate for open abdomen patients.


Asunto(s)
Abdomen/cirugía , Técnicas de Cierre de Herida Abdominal/instrumentación , Diuréticos/administración & dosificación , Terapia de Presión Negativa para Heridas/instrumentación , Torasemida/administración & dosificación , Cicatrización de Heridas , Adulto , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Mallas Quirúrgicas , Resultado del Tratamiento
7.
J Wound Ostomy Continence Nurs ; 46(4): 337-342, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274868

RESUMEN

BACKGROUND: Repair of an enterocutaneous fistula (ECF) is challenging, particularly when complications occur. This case describes the use of negative pressure wound therapy (NPWT) and microadhesive dressings with polyabsorbent fibers and an acrylic core, with and without lipidocolloid and nano-oligosaccharide factors, in the management of a patient with a large abdominal wound and ECF. CASE: An 84-year-old woman underwent abdominoperineal resection with colostomy, hysterectomy, and subsequent chemotherapy and radiotherapy for colorectal cancer. She experienced complications, ultimately resulting in ECF of the jejunum. Initial management with NPWT was used to promote abdominal wound healing, while protecting exposed bowel loops proved challenging because of leakage of stoma effluent that impeded the formation of granulation tissue. In order to promote wound healing and prevent infection, we applied a microadhesive dressing composed of polyabsorbent fibers with an acrylic core and lipidocolloid and nano-oligosaccharide factors that facilitated autolytic debridement and healing. CONCLUSIONS: Use of NPWT with the microadhesive dressing proved successful in the management of this complex and challenging ECF.


Asunto(s)
Pared Abdominal/cirugía , Fístula Intestinal/cirugía , Pared Abdominal/anomalías , Pared Abdominal/fisiopatología , Técnicas de Cierre de Herida Abdominal , Anciano de 80 o más Años , Vendajes/efectos adversos , Vendajes/tendencias , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Fístula Intestinal/fisiopatología , Terapia de Presión Negativa para Heridas/métodos , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/fisiología
8.
A A Pract ; 13(5): 193-196, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31180908

RESUMEN

Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. We report our experience with a new collaborative protocol between general surgery and regional anesthesiology and acute pain medicine services to provide preoperative botulinum toxin A injections to a patient with a large complex ventral hernia to facilitate primary closure. Toxin was administered into the 3 abdominal wall muscle layers under ultrasound guidance at multiple sites 2 weeks before surgery. The resulting flaccid paralysis of the abdominal musculature facilitated a successful primary surgical closure with no postoperative complications.


Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Hernia Ventral/cirugía , Técnicas de Cierre de Herida Abdominal , Femenino , Humanos , Inyecciones Intramusculares , Persona de Mediana Edad , Cuidados Preoperatorios , Resultado del Tratamiento , Ultrasonografía Intervencional
9.
J Trauma Acute Care Surg ; 87(3): 623-629, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31045736

RESUMEN

BACKGROUND: Optimal management following index laparotomy is poorly defined in secondary peritonitis patients. Although "open abdomen" (OA), or temporary abdominal closure with planned relaparotomy, is used to reassess bowel viability or severity of contamination, recent studies demonstrate comparable morbidity and mortality with primary abdominal closure (PC). This study evaluates differences between OA and PC following emergent laparotomy. METHODS: Using the Premier database at a quaternary care center (2012-2016), nontrauma patients with secondary peritonitis requiring emergent laparotomy were identified (N = 534). Propensity matching for PC (n = 331; 62%) or OA (n = 203; 38%) was performed using variables: Mannheim Peritonitis Index, lactate, and vasopressor requirement. One hundred eleven closely matched pairs (PC:OA) were compared. RESULTS: Five hundred thirty-four patients (55.0% female; mean age, 59.6 ± 15.5 years) underwent emergent laparotomy. Of the OA patients, 136 (67.0%) had one relaparotomy, while 67 (33.0%) underwent multiple reoperations. Compared to daytime cases, laparotomies performed overnight (6 pm-6 am) had more temporary closures with OA (42.8% OA vs. 57.2% PC, p = 0.04). When assessing by surgeon type, PC was performed in 78.7% of laparotomies by surgical subspecialties compared to 56.7% (p < 0.0001) of acute care surgeons. After propensity matching, OA patients had increased postoperative complications (71.2% vs. 41.4%, p < 0.0001), mortality (22.5% vs. 11.7%, p = 0.006), and longer median length of stay (13 vs. 9 days, p = 0.0001). CONCLUSION: Open abdomen was performed in 38.0% of patients, with one-third of those requiring multiple reoperations. Complications, mortality rates, and costs associated with OA were significantly increased when compared to PC. Given these findings, future studies are needed to determine appropriate indications for OA. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Peritonitis/cirugía , Abdomen/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Puntaje de Propensión , Resultado del Tratamiento
10.
Ann Surg ; 269(6): 1034-1040, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31082899

RESUMEN

OBJECTIVE: This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection (SSI) after open pancreaticoduodenectomy. BACKGROUND: Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs. Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication. METHODS: We conducted a single-center randomized, controlled trial evaluating surgical incision closure during pancreaticoduodenectomy using negative pressure wound therapy in patients at high risk for SSI. We randomly assigned patients to receive negative pressure wound therapy or a standard wound closure. The primary end point of the study was the occurrence of a postoperative SSI. We evaluated the economic impact of the intervention. RESULTS: From January 2017 through February 2018, we randomized 123 patients at the time of closure of the surgical incision. SSI occurred in 9.7% (6/62) of patients in the negative pressure wound therapy group and in 31.1% (19/61) of patients in the standard closure group (relative risk = 0.31; 95% confidence interval, 0.13-0.73; P = 0.003). This corresponded to a relative risk reduction of 68.8%. SSIs were found to independently increase the cost of hospitalization by 23.8%. CONCLUSIONS: The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs. Incorporating this intervention in surgical practice can help reduce a complication that significantly increases patient harm and healthcare costs.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Terapia de Presión Negativa para Heridas , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Infección de la Herida Quirúrgica/prevención & control , Anciano , Femenino , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento
11.
Semin Pediatr Surg ; 28(2): 89-94, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31072464

RESUMEN

Omphalocele is an abdominal wall defect involving the umbilical ring which results in visceral herniation of small and large intestine, liver, spleen and sometimes gonads. The covering of the herniated viscera by a fused membrane consisting of peritoneum, Wharton's jelly and amnion projects viscera from mechanical injury and exposure to chemical irritants in amniotic fluid. Omphalocele is usually diagnosed before birth, is variable in size, and is frequently associated with chromosomal and somatic anomalies, syndromes, and variable degrees of pulmonary hypoplasia which can be lethal. In this article we examine surgical closure options for omphaloceles ranging from early primary fascial repair for small omphaloceles to a staged repair, often facilitated by an amnion preserving silo, which may be necessary for giant omphaloceles that cannot be closed primarily. We also review some of the adjuncts to abdominal wall reconstruction including tissue expansion and mesh. Conservative management (paint and wait) of giant omphaloceles is described elsewhere.


Asunto(s)
Hernia Umbilical/cirugía , Herniorrafia/métodos , Técnicas de Cierre de Herida Abdominal , Hernia Umbilical/diagnóstico , Humanos , Recién Nacido , Atención Perinatal/métodos , Expansión de Tejido/métodos
12.
Semin Pediatr Surg ; 28(2): 95-100, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31072465

RESUMEN

Management of the very large defect or those in patients with severe comorbidities has evolved to the use of methods that result in escharification and eventual skin coverage over the viscera. This treatment strategy employs principles that were described in the early 20th century. This review will describe the history, principles, methods, and outcomes from the so called 'paint and wait' management of omphalocele.


Asunto(s)
Tratamiento Conservador/métodos , Hernia Umbilical/terapia , Técnicas de Cierre de Herida Abdominal , Antiinfecciosos/uso terapéutico , Terapia Combinada , Fármacos Dermatológicos/uso terapéutico , Quimioterapia Combinada , Hernia Umbilical/complicaciones , Herniorrafia/métodos , Humanos , Recién Nacido
13.
PLoS One ; 14(5): e0216943, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31107892

RESUMEN

Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.


Asunto(s)
Técnicas de Cierre de Herida Abdominal/veterinaria , Hernia Incisional/veterinaria , Laparotomía/veterinaria , Cirugía Veterinaria/métodos , Técnicas de Sutura/veterinaria , Suturas/veterinaria , Abdomen/patología , Abdomen/cirugía , Animales , Peso Corporal , Gatos , Perros , Femenino , Humanos , Hernia Incisional/patología , Hernia Incisional/cirugía , Laparotomía/métodos , Masculino , Cirugía Veterinaria/instrumentación
14.
Plast Surg Nurs ; 39(2): 41-43, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31136556

RESUMEN

Given their high rate of complications, radical surgical procedures of anorectal and gynecological tumors require a reliable and individualized reconstruction. The latter is influenced by the frequent indication of adjuvant chemo/radiotherapy that they present. We describe the case of a patient with medical history of vulvar carcinoma that required radical surgery and bilateral inguinal lymphadenectomy. Because of the stage of the tumor, the application of postoperative radiotherapy was clinically indicated; however, after surgery, the patient developed bilateral inguinal ulcers that made postoperative radiotherapy application impossible. Using a radical surgical approach in combination with postoperative radiotherapy increases survival in patients with these types of tumors. Therefore, delaying its use because of wound complications or inadequate reconstruction cannot be justified. The pedicled abdominal rectus flap is an excellent option for this purpose in patients with moderate- to large-sized defects.


Asunto(s)
Conducto Inguinal/cirugía , Colgajos Quirúrgicos/cirugía , Neoplasias de la Vulva/cirugía , Técnicas de Cierre de Herida Abdominal/normas , Adulto , Femenino , Humanos , Radioterapia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos Quirúrgicos Reconstructivos/normas , Recto del Abdomen/cirugía , Resultado del Tratamiento
15.
World J Gastroenterol ; 25(14): 1775-1782, 2019 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-31011261

RESUMEN

BACKGROUND: Open abdomen (OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the meantime, OA calls for a mass of nursing and the subsequent enteroatomospheric fistula (EAF), which is one of the most common complications of OA therapy, remains a thorny challenge. CASE SUMMARY: Our team applied thermoplastic polyurethane as a befitting material for producing a 3D-printed "fistula stent" in the management of an EAF patient, who was initially admitted to local hospital because of abdominal pain and distension and diagnosed with bowel obstruction. After a series of operations and OA therapy, the patient developed an EAF. CONCLUSION: Application of this novel "fistula stent" resulted in a drastic reduction in the amount of lost enteric effluent and greatly accelerated rehabilitation processes.


Asunto(s)
Pared Abdominal/cirugía , Técnicas de Cierre de Herida Abdominal/instrumentación , Fístula Intestinal/cirugía , Impresión Tridimensional , Adulto , Anastomosis Quirúrgica/efectos adversos , Angiografía , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Obstrucción Intestinal/cirugía , Masculino , Poliuretanos , Stents , Resultado del Tratamiento
16.
J Wound Care ; 28(4): 240-244, 2019 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-30975060

RESUMEN

Negative pressure wound therapy (NPWT) is a widely used wound management system. Several articles have been published on the advantages and complications of this system. Abdominal dressing negative pressure system (abdominal NPWT) is a newer technology, developed and used in open abdomen cases. The adherence of the sponge to the intra-abdominal organs is prevented by a polyurethane foam. This study presents a number of case series where an abdominal NPWT (ABThera, KCI, US) has been used to treat other vital organs, helping to prevent complications such as organ rupture and fatal bleeding.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Terapia de Presión Negativa para Heridas , Herida Quirúrgica/terapia , Heridas y Traumatismos/terapia , Adulto , Brazo , Nalgas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tórax , Resultado del Tratamiento , Cicatrización de Heridas , Heridas por Arma de Fuego/terapia
17.
J Laparoendosc Adv Surg Tech A ; 29(6): 856-859, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30900956

RESUMEN

Introduction: Closure of the hernia defect during laparoscopic ventral hernia repair (LVHR) remains controversial. We aimed to analyze whether closing hernia defects impacts in postoperative morbidity and recurrence rates after LVHR. Materials and Methods: A consecutive series of patients undergoing LVHR from January 2014 to June 2017 with a minimum follow-up of 6 months were included. The sample was divided into two groups: DC, patients with fascial defect closure and NDC, patients without closure of the defect. Postoperative morbidity and recurrence rates were compared between both groups. Results: A total of 100 patients were included, 51 had their defects closed (DC) and the remaining 49 patients had their defects not closed (NDC). There were no significant differences between groups regarding gender, age, smoking, body mass index, or preoperative American Society of Anesthesiologists. Defect area was similar in both groups (DC: 37 cm2 versus 42 cm2 NDC, P = .6). Patients with defect closure had significantly longer operating time (DC: 111 and NDC: 88 minutes, P < .01). Patients without defect closure showed higher rates of postoperative seroma (DC: 10% versus NDC: 18%) and bulging (DC: 4% versus NDC: 12.2%). After a mean follow-up of 24 (6-36) months, recurrence was 6% in DC and 18% in NDC (P = .07). Closure of the defect in midline hernias showed a significant reduction of the recurrence rate (DC: 2/39 [5%] versus NDC: 5/21 [24%], P = .04). Conclusion: Defect closure in LVHR seems to reduce postoperative morbidity and recurrence rates, especially in midline defects. Systematic closure of the hernia defect should be encouraged to improve postoperative outcomes.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Hernia Ventral/cirugía , Herniorrafia/métodos , Hernia Incisional/cirugía , Laparoscopía/métodos , Adulto , Anciano , Fascia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
18.
Surg Technol Int ; 34: 115-119, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-30888675

RESUMEN

BACKGROUND: Negative pressure therapy (NPT) seems to improve surgical outcomes in open abdomen (OA) management of severe intra-abdominal infections (IAIs). The aim of this study was to compare the effects of immediate vs. delayed application of NPT on outcomes in patients with IAIs after colonic perforation. MATERIALS AND METHODS: We analysed 38 patients who received NPT during OA management for IAI after colonic perforation. The endpoints were treatment duration, definitive fascial closure and in-hospital mortality. We subdivided patients according to the timing of NPT application: immediate (at the end of the first OA procedure) and delayed (at I-II revision, at III revision, and after III revision). RESULTS: NPT was applied immediately in 15 cases (39.5%) and was delayed in 23 (60.5%): 14 (36.8%) at I-II revision, 7 (18.4%) at III revision, and 2 (5.3%) after III revision. Immediate NPT application was associated with the best outcomes. CONCLUSIONS: NPT should be used as soon as possible in OA management for IAIs due to colonic perforation.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Enfermedades del Colon/cirugía , Perforación Intestinal/cirugía , Infecciones Intraabdominales/prevención & control , Terapia de Presión Negativa para Heridas , Enfermedades del Colon/complicaciones , Mortalidad Hospitalaria , Humanos , Perforación Intestinal/complicaciones , Infecciones Intraabdominales/etiología , Infecciones Intraabdominales/mortalidad , Infecciones Intraabdominales/terapia , Reoperación , Factores de Tiempo
19.
World J Surg ; 43(7): 1669-1675, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30824961

RESUMEN

OBJECTIVES: Incisional hernia, a serious complication after laparotomy, is associated with high morbidity and costs. This trial examines the value of prophylactic intraperitoneal onlay mesh to reduce the risk of incisional hernia after a median follow-up time of 5.3 years. METHODS: We conducted a parallel group, open-label, single center, randomized controlled trial (NCT01003067). After midline incision, the participants were either allocated to abdominal wall closure according to Everett with a PDS-loop running suture reinforced by an intraperitoneal composite mesh strip (Group A) or the same procedure without the additional mesh strip (Group B). RESULTS: A total of 276 patients were randomized (Group A = 131; Group B = 136). Follow-up data after a median of 5.3 years after surgery were available from 183 patients (Group A = 95; Group B = 88). Incisional hernia was diagnosed in 25/95 (26%) patients in Group A and in 46/88 (52%) patients in Group B (risk ratio 0.52; 95% CI 0.36-0.77; p < 0.001). Eighteen patients with asymptomatic incisional hernia went for watchful waiting instead of hernia repair and remained free of symptoms after of a median follow-up of 5.1 years. Between the second- and fifth-year follow-up period, no complication associated with the mesh could be detected. CONCLUSION: The use of a composite mesh in intraperitoneal onlay position significantly reduces the risk of incisional hernia during a 5-year follow-up period. TRIAL REGISTRATION NUMBER: Ref. NCT01003067 (clinicaltrials.gov).


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Hernia Ventral/prevención & control , Hernia Incisional/prevención & control , Mallas Quirúrgicas , Abdomen/cirugía , Estudios de Seguimiento , Hernia Ventral/etiología , Hernia Ventral/cirugía , Herniorrafia , Humanos , Hernia Incisional/etiología , Hernia Incisional/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Mallas Quirúrgicas/efectos adversos , Suturas
20.
J Photochem Photobiol B ; 192: 124-130, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30735953

RESUMEN

Wound dehiscence is a surgical complication and its management is inevitable because 25% to 35% of patients suffered from post laparotomy wound dehiscence. The excellent biodegradability and biocompatibility of chitosan and alginate have provided ample space for future developments in biomedical applications. Hence, the present work is directed towards the synthesis of robust biofilm made up of chitosan (CS), zinc oxide (ZnO) nanoparticles and Alginate (Alg). Chitosan and alginate were used for their pore forming ability, and ZnO is for its antibacterial action. The proposed biofilm was characterized with different characterization techniques such as Fourier Transform Infrared (FTIR) spectroscopy, UV-vis spectroscopy, X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and Transmission Electron microscopy (TEM) analyses. FTIR results inferred the strong interaction between the three components. The surface morphology of ZnO-CS/Alg. biofilm was exhibited as the spherical shaped nanoparticles which are firmly anchored on the polymer matrix. TEM analysis also confirmed the formation of biofilm. The XRD analysis confirmed the presence of ZnO in the biopolymer. The line broadening suggests that the crystallize size is in few nanometers. The average crystallite size was estimated as 50 nm using Scherrer formula. The antibacterial activity of the biofilm was successfully established against bacterial pathogens. Therefore, the developed materials have a potential play as antimicrobial role for the abdominal wound healing and biomedical fields.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Antiinfecciosos Locales/farmacología , Biopelículas , Nanopartículas del Metal/química , Dehiscencia de la Herida Operatoria/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacos , Alginatos , Bacterias/efectos de los fármacos , Quitosano , Humanos , Nanopartículas , Óxido de Zinc/química
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