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World Journal of Emergency Surgery :... Jul 2023Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure... (Review)
Review
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
Topics: Humans; Laparotomy; Abdominal Wound Closure Techniques; Suture Techniques; Incisional Hernia; Reoperation
PubMed: 37496068
DOI: 10.1186/s13017-023-00511-w -
Ugeskrift For Laeger Mar 2018
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Humans; Laparotomy; Postoperative Complications; Suture Techniques
PubMed: 29559073
DOI: No ID Found -
BJS Open Jul 2023Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique.
METHODS
The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords 'laparotomy closure', 'mesh', 'mesh positioning', and 'prophylactic mesh', and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials.
RESULTS
Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant.
CONCLUSIONS
Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings.
PROSPERO REGISTRATION ID
CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).
Topics: Humans; Incisional Hernia; Laparotomy; Surgical Mesh; Incidence; Abdominal Wound Closure Techniques
PubMed: 37504969
DOI: 10.1093/bjsopen/zrad060 -
International Wound Journal Apr 2023We performed a meta-analysis to evaluate the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in... (Meta-Analysis)
Meta-Analysis
Effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer: A meta-analysis.
We performed a meta-analysis to evaluate the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer. A systematic literature search up to July 2022 was performed and 10 231 subjects with cervical cancer at the baseline of the studies; 4307 of them were using the minimally invasive surgery, and 5924 were using laparotomy. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer using the dichotomous methods with a random or fixed-effect model. The minimally invasive surgery had significantly lower wound infection (OR, 0.20; 95% CI, 0.13-0.30, P < .001), and postoperative complications (OR, 0.48; 95% CI, 0.37-0.64, P < .001) in subjects with cervical cancer compared laparotomy. However, minimally invasive surgery compared with laparotomy in subjects with cervical cancer had no significant difference in intraoperative complications (OR, 1.04; 95% CI, 0.80-1.36, P = 0.76). The minimally invasive surgery had significantly lower wound infection, and postoperative complications however, had no significant difference in intraoperative complications in subjects with cervical cancer compared with laparotomy. The analysis of outcomes should be with caution because of the low sample size of 22 out of 41 studies in the meta-analysis and a low number of studies in certain comparisons.
Topics: Female; Humans; Uterine Cervical Neoplasms; Laparotomy; Postoperative Complications; Intraoperative Complications; Wound Infection; Minimally Invasive Surgical Procedures
PubMed: 36111540
DOI: 10.1111/iwj.13962 -
Gynecologic Oncology Jul 2023Robotic-assisted laparoscopy (RALS) has gained widespread acceptance in the field of gynecological oncology. However, whether the prognosis of endometrial cancer after... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Robotic-assisted laparoscopy (RALS) has gained widespread acceptance in the field of gynecological oncology. However, whether the prognosis of endometrial cancer after RALS is superior to conventional laparoscopy (CLS) and laparotomy (LT) remains inconclusive. Therefore, the aim of this meta-analysis was to compare the long-term survival outcomes of RALS with CLS and LT for endometrial cancer.
METHODS
A systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed.
RESULTS
RALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922-1.004), RFS (HR = 1.096, 95% CI: 0.947-1.296), and DSS (HR = 1.489, 95% CI: 0.713-3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576-0.807), RFS (HR = 0.793, 95% CI: 0.653-0.964), and DSS (HR = 0.441, 95% CI: 0.298-0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS.
CONCLUSIONS
RALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
Topics: Female; Humans; Laparotomy; Robotic Surgical Procedures; Endometrial Neoplasms; Endometrium; Laparoscopy
PubMed: 37149906
DOI: 10.1016/j.ygyno.2023.04.026 -
Journal of Visceral Surgery Aug 2016The goal of abbreviated laparotomy is to treat severely injured patients whose condition requires an immediate surgical operation but for whom a prolonged procedure... (Review)
Review
The goal of abbreviated laparotomy is to treat severely injured patients whose condition requires an immediate surgical operation but for whom a prolonged procedure would worsen physiological impairment and metabolic failure. Indeed, in severely injured patients, blood loss and tissue injuries enhance the onset of the "bloody vicious circle", triggered by the triad of acidosis-hypothermia-coagulopathy. Abbreviated laparotomy is a surgical strategy that forgoes the completeness of operation in favor of a physiological approach, the overriding preference going to rapidity and limiting the procedure to control the injuries. Management is based on sequential association of the shortest possible preoperative resuscitation with surgery limited to essential steps to control injury (stop the bleeding and contamination), without definitive repair. The latter will be ensured during a scheduled re-operation after a period of resuscitation aiming to correct physiological abnormalities induced by the trauma and its treatment. This strategy necessitates a pre-defined plan and involvement of the entire medical and nursing staff to reduce time loss to a strict minimum.
Topics: Emergencies; Hemorrhage; Humans; Laparotomy; Reoperation; Resuscitation; Wounds and Injuries
PubMed: 27542655
DOI: 10.1016/j.jviscsurg.2016.07.002 -
Laparoscopy versus laparotomy in the repair of ventral hernias: systematic review and meta-analysis.Arquivos de Gastroenterologia 2014To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia.
METHODS
This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS), using a combination of the terms (Hernia, Ventral) and (Laparoscopy) and (Laparotomy).
RESULTS
Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5) and seroma formation (NNT = 13) and less length hospitalization (P = 0.02) compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25) and post operative pain (NNH = 8) and longer surgical time (P = 0.0009) when compared with laparotomy. There was no difference related to abscess (P = 0.79), hematoma (P = 0.43) and recurrency of ventral hernias (P = 0.25).
CONCLUSIONS
In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation, as well as, decrease the length hospitalization.
Topics: Hernia, Ventral; Humans; Laparoscopy; Laparotomy; Length of Stay; Operative Time; Randomized Controlled Trials as Topic; Recurrence
PubMed: 25296080
DOI: 10.1590/s0004-2803201400030008 -
Open Veterinary Journal 2021The objective of the study to evaluate the effect of electroacupuncture during laparotomy in goats.
BACKGROUND
The objective of the study to evaluate the effect of electroacupuncture during laparotomy in goats.
AIM
To study the abdominal anesthesia in goats by electroacupuncture using the physiological variables, vital parameters, hematological, biochemical, cortisol hormone, pain threshold, and wound healing for laparotomy in goats.
METHODS
Fifteen healthy adult bucks were used to receive electroacupuncture in 10 newly selected acupoints. The data (M ± SD) were assessed at intervals (0 minutes) before induction (control group), (5 minutes), (10 minutes), (15 minutes), and (20 minutes) during induction, (30 minutes), (45 minutes), and (60 minutes) throughout surgery and (24 hours) after surgery, cortisol levels in serum at (0), (24 hours), and (72 hours) throughout laparotomy.
RESULTS
The goats of the study showed improvement in the rates of eyelid closure, head, and neck relaxation, rumen motility, and tympany which were graded into mild (+), moderate (++), and severe (+++) degrees. The respiratory rates, body temperatures, and capillary fill times were not significantly different. The total mean of hematocrit was (19.9 ± 2.68), the total mean of hemoglobin was (9.9 ± 0.94), the total mean of red blood cells was (7.9 ± 0.8), the total mean of platelets was (244,861.3 ± 138,444.8) and the total mean of SPO2 was (70.5 ± 4.6). ALT and AST showed no significance. The significant mean cortisol level was (2.6 ± 2.01) and the significant mean pain threshold level was (0.02 ± 0.03). The results proved that electroacupuncture had a lot of significant parameters. The wound healing was improved by early epithelization and immature granulation tissue (at 7 days). Thick keratinized epithelization and collagen deposition in the dermal tissue with enhanced angiogenesis (at 14 days). Mild restoration of skin and the dermal tissue was well-organized (at 21 days). Besides, well-formed scar tissue covering a highly cellular organized dermal tissue (at 28 days).
CONCLUSIONS
Electroacupuncture had been considered a powerful anesthetic for abdominal surgery in goats. Moreover, wound healing proved excellent and better healing.
Topics: Acupuncture Analgesia; Animals; Electroacupuncture; Goats; Hydrocortisone; Laparotomy; Male; Pain Threshold; Vital Signs; Wound Healing
PubMed: 33898284
DOI: 10.4314/ovj.v11i1.9 -
World Journal of Emergency Surgery :... May 2023Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study.
METHODS
The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer.
DISCUSSION
OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention.
TRIAL REGISTRATION
National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).
Topics: Humans; Abdomen; Inflammation; Laparotomy; Multiple Organ Failure; Prospective Studies; United States
PubMed: 37170123
DOI: 10.1186/s13017-023-00500-z -
Journal of Visceral Surgery Sep 2013
Topics: Blood Loss, Surgical; Humans; Laparotomy; Postoperative Hemorrhage; Tampons, Surgical
PubMed: 24012718
DOI: 10.1016/j.jviscsurg.2013.07.004