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World Journal of Surgery Apr 2015Several challenging clinical situations in patients with peritonitis can result in an open abdomen (OA) and subsequent temporary abdominal closure (TAC). Indications and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several challenging clinical situations in patients with peritonitis can result in an open abdomen (OA) and subsequent temporary abdominal closure (TAC). Indications and treatment choices differ among surgeons. The risk of fistula development and the possibility to achieve delayed fascial closure differ between techniques. The aim of this study was to review the literature on the OA and TAC in peritonitis patients, to analyze indications and to assess delayed fascial closure, enteroatmospheric fistula and mortality rate, overall and per TAC technique.
METHODS
Electronic databases were searched for studies describing the OA in patients of whom 50% or more had peritonitis of a non-traumatic origin.
RESULTS
The search identified 74 studies describing 78 patient series, comprising 4,358 patients of which 3,461 (79%) had peritonitis. The overall quality of the included studies was low and the indications for open abdominal management differed considerably. Negative pressure wound therapy (NPWT) was the most frequent described TAC technique (38 of 78 series). The highest weighted fascial closure rate was found in series describing NPWT with continuous mesh or suture mediated fascial traction (6 series, 463 patients: 73.1%, 95% confidence interval 63.3-81.0%) and dynamic retention sutures (5 series, 77 patients: 73.6%, 51.1-88.1%). Weighted rates of fistula varied from 5.7% after NPWT with fascial traction (2.2-14.1%), 14.6% (12.1-17.6%) for NPWT only, and 17.2% after mesh inlay (17.2-29.5%).
CONCLUSION
Although the best results in terms of achieving delayed fascial closure and risk of enteroatmospheric fistula were shown for NPWT with continuous fascial traction, the overall quality of the available evidence was poor, and uniform recommendations cannot be made.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Cutaneous Fistula; Fasciotomy; Humans; Intestinal Fistula; Negative-Pressure Wound Therapy; Peritonitis; Surgical Mesh; Sutures
PubMed: 25446477
DOI: 10.1007/s00268-014-2883-6 -
Journal of Pediatric Surgery Sep 2021Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement... (Review)
Review
BACKGROUND
Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement regarding the superiority of one of the two techniques can be made. This study aims to provide evidence supporting the superiority of intra- or extra-corporeal suturing technique.
METHODS
A systematic literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases. Randomised controlled trials and prospective studies comparing different laparoscopic techniques were eligible for inclusion. Data were pooled using a random-effects model, comparing single-port extra-peritoneal closure to intra-peritoneal purse string suture closing. Primary outcome was recurrence rate. Secondary outcomes were duration of surgery (min), peri‑ and post-operative complications (i.e. injury of spermatic vessels or spermatic cord, tuba lesions, bleeding and apnoea, haematoma/scrotal oedema, hydrocele, wound infection, iatrogenic ascent of the testis and testicular atrophy), contralateral patent processus vaginalis (CPPV) rate, post-operative pain, length of hospital stay and cosmetic appearance of the wound.
RESULTS
Fifteen studies (n = 3680 patients, age range 0.5-12 years, follow-up range 3-10 months) were included is this systematic review. Intra-corporeal hernia repair was performed in 738 children and extra-corporeal repair was performed in 2942 children. A pooled data analysis could only be performed for the single port extra-corporeal closing technique and the three port intra-corporeal closing technique. We found that recurrence rate was lower in the single-port extra-corporeal closing technique compared to the intra-corporeal purse suture closing technique (0.6% vs 5.5%, 95% CI 0.107 (0.024-0.477); p < 0.001). Operation time was shorter for extra-corporeal unilateral and bilateral inguinal hernia repair compared with intra-corporeal approach, but no pooled data analysis could be performed. Due to the presence of substantial heterogeneity, it was not possible to assess other outcome measures.
CONCLUSION
Single-port extra-corporeal closure seems to result in less recurrent hernias and a shorter operative time compared to intra-corporeal purse suture closing technique. No difference regarding peri‑ and post-operative complications could be found and no statements regarding the length of hospital admission, post-operative pain and cosmetics could be made due to substantial heterogeneity.
LEVEL OF EVIDENCE
Level II.
Topics: Child; Data Analysis; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Infant, Newborn; Laparoscopy; Male; Prospective Studies; Treatment Outcome
PubMed: 33674123
DOI: 10.1016/j.jpedsurg.2021.01.049 -
Journal of Minimally Invasive Gynecology 2014We conducted a meta-analysis comparing the efficacy of laparoscopic suturing with or without barbed suture for myomectomy or hysterectomy. We used a systematic... (Meta-Analysis)
Meta-Analysis
We conducted a meta-analysis comparing the efficacy of laparoscopic suturing with or without barbed suture for myomectomy or hysterectomy. We used a systematic electronic search strategy of published literature using the following databases: Cochrane Database of Systematic Reviews, MEDLINE, Embase, and OVID MEDLINE In-Process & Other Non-Indexed Citations databases. The following medical subject heading terms, key words, and their combinations were used: laparoscopy, myomectomy, hysterectomy, and barbed suture. Studies in which women undergoing laparoscopic myomectomy or hysterectomy using barbed suture or conventional suture were selected. The main outcome measures chosen for the current meta-analysis were operative time, suturing time, estimated blood loss or change in hemoglobin level, and degree of suturing difficulty. The results of the meta-analysis studies were expressed as the standardized mean difference (SMD) with 95% confidence intervals (CIs). Compared with the use of conventional suture, the total operative time of laparoscopic myomectomy (SMD = -0.58; 95% CI, -0.88 to -0.28) and the suturing time to close the uterine incision (SMD = -1.38; 95% CI, -1.86 to -0.90) were significantly reduced with the use of barbed suture. Meta-analysis on laparoscopic hysterectomy shows that the time to suture the vaginal vault, the total operative time, and the estimated blood loss were comparable with or without the use of barbed suture. The degree of suturing difficulty was reported in 2 randomized trials. Compared with the use of conventional suture, the degree of suturing difficulty was lower with the use of barbed suture (SMD = -1.39; 95% CI, -1.83 to -0.95). The use of barbed suture facilitates laparoscopic suturing of myomectomy incision and closure of the vaginal vault. Its use is associated with a reduced operative time of laparoscopic myomectomy.
Topics: Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Operative Time; Randomized Controlled Trials as Topic; Sutures; Uterine Myomectomy; Vagina
PubMed: 24126257
DOI: 10.1016/j.jmig.2013.09.014 -
The Journal of Foot and Ankle Surgery :... Sep 2019Ankle fractures accompanied by syndesmotic rupture are a complex challenge for orthopedic surgeons. Sufficient reduction and stabilization of the syndesmosis are... (Comparative Study)
Comparative Study Meta-Analysis
Ankle fractures accompanied by syndesmotic rupture are a complex challenge for orthopedic surgeons. Sufficient reduction and stabilization of the syndesmosis are important to prevent early degeneration of the ankle joint and to optimize clinical outcomes. The purpose of the study was to systematically review the literature comparing the suture-button fixation method with the cortical screw fixation method when treating syndesmotic rupture. For this, a systematic review of the literature was performed that included Cochrane, PubMed, and Embase. The following search terms were used: ankle fractures, syndesmosis rupture, tibiofibular syndesmosis injury, ankle joint, tightrope, and suture button. Inclusion criteria were comparison studies, acute ankle fractures with syndesmotic rupture, adult patients, and Coleman score >60. Cadaveric studies, chronic instability, open fractures, polytrauma, and arthropathies were exclusion criteria. Two investigators independently reviewed titles and relevant abstracts. Reoperation and malreduction rates were compared in a meta-analysis. Six studies with 275 patients were included: 2 randomized controlled trials and 2 prospective and 2 retrospective cohort studies. All studies used similar surgical techniques. Functional outcomes (American Orthopedic Foot and Ankle Society scale and the Olerud-Molander score) were not quantitatively comparable. No significantly less number of malreduction events were detected in the suture-button group (risk ratio = 0.19, 95% confidence interval 0.03 to 1.04, p = .06). Significantly lower reoperation rate was detected in the suture-button group (risk ratio = 0.21, 95% confidence interval 0.06 to 0.69, p = .01). We conclude that the suture-button technique showed a significantly lower reoperation rate and tendency toward less malreduction and better American Orthopedic Foot and Ankle Society scale scores. This finding is clinically relevant; however, this conclusion is primarily based on 2 studies, and therefore the interest for further research increases.
Topics: Ankle Fractures; Bone Screws; Fracture Fixation, Internal; Humans; Rupture; Suture Techniques; Sutures
PubMed: 31474406
DOI: 10.1053/j.jfas.2018.12.006 -
Langenbeck's Archives of Surgery Aug 2023Anastomotic leakage (AL) is a common postoperative complication of rectal cancer, with an incidence of about 10%, and the efficacy of reinforced sutures for preventing... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Anastomotic leakage (AL) is a common postoperative complication of rectal cancer, with an incidence of about 10%, and the efficacy of reinforced sutures for preventing AL remains contentious. This study investigated the safety and effectiveness of reinforcement sutures for preventing AL after rectal cancer surgery.
METHODS
The present authors conducted a systematic search in the PubMed, Embase, Cochrane Library, Sinomed, Web of Science, Wanfang, VIP, and CNKI databases for randomized controlled trials (RCTs) and nonrandomized studies up to June 2023. We performed a meta-analysis to evaluate the efficacy of anastomotic reinforcement sutures after rectal cancer surgery. The primary outcome measures were AL, anastomotic bleeding, and infection rates.
RESULTS
Eleven articles (1921 subjects) were analyzed, with 912 and 1009 cases in the reinforced and unreinforced suture groups, respectively. The reinforced suture group showed a lower AL incidence (odds ratio [OR]=0.25, 95% CI 0.17-0.37, P< 0.00001), lower infection rate (OR=0.41, 95%CI 0.19-0.89, P<0.05), shorter hospital stay (mean difference [MD]=-0.57, 95%CI -1.15-0.00, P≤0.05), and earlier anal exhaust (MD=-0.12, 95%CI -0.23-0.00, P<0.05). However, the operative time (MD=18.25, 95% CI 12.20-24.30, P<0.00001) was longer for reinforced sutures than for unreinforced sutures. There were no significant differences between the suture techniques in intraoperative blood loss MD=2.74, 95% CI -4.50-9.97, P>0.05), incidence of anastomotic bleeding (OR=0.49, 95%CI 0.12-1.97, P>0.05), and incidence of intestinal obstruction (OR=0.65, 95%CI 0.27-1.61, P>0.05).
CONCLUSION
Existing articles indicate that anastomotic reinforcement sutures can significantly reduce AL incidence. However, this conclusion still requires confirmation based on multicentre, high-quality RCTs with large sample sizes.
Topics: Humans; Anastomotic Leak; Anastomosis, Surgical; Rectal Neoplasms; Sutures; Treatment Outcome
PubMed: 37594605
DOI: 10.1007/s00423-023-03058-1 -
Journal of Clinical Medicine Sep 2023Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one,... (Review)
Review
Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches.
Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.
PubMed: 37834810
DOI: 10.3390/jcm12196166 -
Medicine May 2020Barbed suture has been widely used in some surgical fields, and it has achieved good results, but the application in total knee arthroplasty is still controversial. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Barbed suture has been widely used in some surgical fields, and it has achieved good results, but the application in total knee arthroplasty is still controversial.
OBJECTIVE
Literature is collected for statistical analysis so as to provide evidence for the use of barbed suture in Total knee arthroplasty.
METHODS
We searched PubMed, the Cochrane library and EMBASE database for randomized controlled trials (RCTs) using barbed suture and conventional suture to close incisions after primary total knee arthroplasty, and the retrieval time was from July 2019 to the establishment of the database. Literature was screened according to inclusion and exclusion criteria, quality evaluation and data extraction were conducted for the final included literature, and statistical analysis was conducted using RevMan 5.3 software.
RESULTS
A total of six RCTs (826 knees) were included in our meta-analysis. The results showed that the re-negative conversion could shorten the wound closure time (MD -4.41, 95% CI -5.11 to -3.72, P < .00001) and reduce the wound closure total cost (MD -282.61, 95% CI -445.36 to -119.85, P = .0007) and acupuncture injury (RR 0.14, 95% CI 0.03-0.78, P = .02), and did not significantly increasing the incidence of complications (RR 0.80, 95% CI 0.05-0.96, P = .38) or suture breakages (RR 4.58, 95% CI 0.16-128.29, P = .37). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD -0.74, 95% CI -4.19 to 2.71, P = .67; MD -0.30, 95% CI -2.62 to 2.02, P = .80) and no significant differences in KSS at postoperative 6 weeks (MD -0.22, 95% CI -3.10 to 2.66, P = .88).
CONCLUSIONS
Our study shows that barbed suture is a fast, low-cost, safe and effective suture method in total knee arthroplasty compared with traditional suture, we also need more literature and longer follow-up to confirm this conclusion.
Topics: Arthroplasty, Replacement, Knee; Equipment Design; Humans; Randomized Controlled Trials as Topic; Sutures
PubMed: 32481258
DOI: 10.1097/MD.0000000000019945 -
The Cochrane Database of Systematic... Jun 2010Approximately 70% of women will experience perineal trauma following vaginal delivery and will require stitches. This may result in pain, suture removal and superficial... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Approximately 70% of women will experience perineal trauma following vaginal delivery and will require stitches. This may result in pain, suture removal and superficial dyspareunia.
OBJECTIVES
To assess the effects of different suture materials on short- and long-term morbidity following perineal repair.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).
SELECTION CRITERIA
Randomised trials comparing different suture materials for perineal repair after vaginal delivery.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS
We included 18 trials with 10,171 women; comparisons included: catgut with standard synthetic (nine trials), rapidly absorbing synthetic (two trials), and glycerol impregnated catgut sutures (two trials); and standard synthetic sutures with rapidly absorbing synthetic (five trials) and monofilament sutures (one trial).Compared with catgut, standard synthetic sutures were associated with less pain up to three days after delivery (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90); and less analgesia up to ten days postpartum (RR 0.71, 95% CI 0.59 to 0.87). More women with catgut sutures required resuturing (15/1201) compared with synthetic sutures (3/1201) (RR 0.25, 95% CI 0.08 to 0.74); while more women with standard synthetic sutures required the removal of unabsorbed suture material (RR 1.81, 95% CI 1.46 to 2.24). Comparing standard synthetic with rapidly absorbing sutures, short- and long-term pain were similar; in one trial fewer women with rapidly absorbing sutures reported using analgesics at 10 days (RR 0.57, 95% CI 0.43 to 0.77). More women in the standard synthetic suture group required suture removal compared with those in the rapidly absorbed group (RR 0.24, 95% CI 0.15 to 0.36). There was no evidence of significant differences between groups for long-term pain (three months after delivery) or for dyspareunia at three, or at six to 12 months. When catgut and glycerol impregnated catgut were compared, results were similar for most outcomes, although the latter was associated with more short-term pain. One trial examining monofilament versus standard polyglycolic sutures found no differences for most outcomes.
AUTHORS' CONCLUSIONS
Catgut may increase short-term pain compared with synthetic sutures. There were few differences between standard and rapidly absorbing synthetic sutures but more women needed standard sutures removing. For other materials, there was insufficient evidence to draw conclusions. Findings should be interpreted in the context of the related Cochrane review on suturing techniques.
Topics: Absorbable Implants; Catgut; Delivery, Obstetric; Episiotomy; Female; Humans; Perineum; Polyglactin 910; Polyglycolic Acid; Pregnancy; Randomized Controlled Trials as Topic; Sutures
PubMed: 20556745
DOI: 10.1002/14651858.CD000006.pub2 -
Acta of Bioengineering and Biomechanics 2021As a rule, wound healing is a natural and spontaneous process. However, in acute or surgical wounds, the wound edges need to be approximated and held together by...
PURPOSE
As a rule, wound healing is a natural and spontaneous process. However, in acute or surgical wounds, the wound edges need to be approximated and held together by artificial means. Surgery within the abdominal cavity or elsewhere almost always involves cutting through the skin, after which a medical procedure is conducted, followed by wound closure. The suture provides temporary mechanical support during the natural healing process of the affected tissues. Not only does it stimulate the primary wound healing, but also provides mechanical protection against wound dehiscence.
METHODS
This analysis is intended to juxtapose the basic factors that contribute to a change in suture strength and the possible failure of surgical sutures, which may affect the wound healing process and increase the risk of postoperative complications.
RESULTS
The preliminary search criteria used in the databases included keywords such as: "strength of suture materials", "strength of surgical sutures", "surgical knot strength". Five key articles were ultimately selected from a pool of 336 articles first identified based on these search criteria. Next, a meta-analysis of the literature data was performed, taking into account factors such as the type of suture materials used, biological conditions and model conditions used in research, having a significant impact on the mechanical properties of surgical sutures.
CONCLUSIONS
This comparison revealed considerable variations in the suture strength between different sutures of the same size, it also demonstrated that the decrease in suture strength strongly depends on the finished suture and the thread type.
PubMed: 37341129
DOI: No ID Found -
PloS One 2015The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures.
OBJECTIVE
To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates.
METHODS
We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm.
RESULTS
Fifty-six papers, describing 83 separate groups comprising 14,618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis.
CONCLUSIONS
The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Humans; Incidence; Incisional Hernia; Laparotomy; Observational Studies as Topic; Postoperative Complications; Randomized Controlled Trials as Topic; Regression Analysis; Risk Factors; Suture Techniques
PubMed: 26389785
DOI: 10.1371/journal.pone.0138745