Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations
Severe obesity is cited as a major risk factor for fascial wound dehisence and late incisional hernia after major abdominal surgery. The purpose of this study was to prospectively compare two methods of closure of the linea alba after gastric restrictive operations performed for treatment of morbid...
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| Veröffentlicht in: | The American journal of surgery 1996-10, Vol.172 (4), p.328-331 |
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| description | Severe obesity is cited as a major risk factor for fascial wound dehisence and late incisional hernia after major abdominal surgery. The purpose of this study was to prospectively compare two methods of closure of the linea alba after gastric restrictive operations performed for treatment of morbid obesity.
During a 6-year period 229 patients were randomized to have closure of the midline fascia using either a double-stranded #1 PDS suture placed in a continuous fashion or #1 Ethibond suture placed using an interrupted figure-eight technique.
Two of 109 patients who had closure with Ethibond suffered an acute dehiscence of the midline fascia vs no cases of fascial dehiscence in the PDS group. There were no wound infections in either group. There were 20 late incisional hernias (18%) in the Ethibond group vs 11 late hernias (10%) in the PDS group (
P ≤0.04). Mean postoperative follow-up time for all patients was 29.4 months. The cost of suture material and the time required to completely close the linea alba were also calculated for each group. The mean closure time in the Ethibond group was 13.3 vs 9.1 minutes in the PDS group (
P |
| doi_str_mv | 10.1016/S0002-9610(96)00194-8 |
| format | Article |
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During a 6-year period 229 patients were randomized to have closure of the midline fascia using either a double-stranded #1 PDS suture placed in a continuous fashion or #1 Ethibond suture placed using an interrupted figure-eight technique.
Two of 109 patients who had closure with Ethibond suffered an acute dehiscence of the midline fascia vs no cases of fascial dehiscence in the PDS group. There were no wound infections in either group. There were 20 late incisional hernias (18%) in the Ethibond group vs 11 late hernias (10%) in the PDS group (
P ≤0.04). Mean postoperative follow-up time for all patients was 29.4 months. The cost of suture material and the time required to completely close the linea alba were also calculated for each group. The mean closure time in the Ethibond group was 13.3 vs 9.1 minutes in the PDS group (
P <0.0001). Although the cost per suture pack of #1 PDS was $4.63 vs $1.76 per pack for #1 Ethibond, the mean cost of sutures per patient was $4.81 for PDS vs $11.09 for Ethibond.
We conclude that #1 PDS placed in a continuous fashion provides a more secure and cost-effective closure of the midline fascia in morbidly obese patients than #1 Ethibond placed using an interrupted figure-eight technique.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/S0002-9610(96)00194-8</identifier><identifier>PMID: 8873523</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Anastomosis, Roux-en-Y ; Antibiotic Prophylaxis ; Biological and medical sciences ; Chi-Square Distribution ; Dehiscence ; Fascia ; Female ; Follow-Up Studies ; Gastric Bypass - methods ; Gastroplasty - methods ; Granuloma, Foreign-Body - etiology ; Hernia ; Hernia - etiology ; Hernias ; Humans ; Male ; Medical sciences ; Middle Aged ; Obesity ; Obesity, Morbid - surgery ; Patients ; Prospective Studies ; Risk factors ; Stomach - surgery ; Stomach, duodenum, intestine, rectum, anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Surgical Wound Dehiscence - etiology ; Suture Techniques - adverse effects ; Suture Techniques - economics ; Sutures ; Wound infection</subject><ispartof>The American journal of surgery, 1996-10, Vol.172 (4), p.328-331</ispartof><rights>1996 Excerpta Medica, Inc.</rights><rights>1996 INIST-CNRS</rights><rights>1996. Excerpta Medica, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-6146ca4ef8a4cc8e31c9adc1d9be2ee68a8542820f9c279ebbb87a326bd245183</citedby><cites>FETCH-LOGICAL-c483t-6146ca4ef8a4cc8e31c9adc1d9be2ee68a8542820f9c279ebbb87a326bd245183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2847439371?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986,64374,64376,64378,72230</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3253934$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8873523$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brolin, Robert E.</creatorcontrib><title>Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Severe obesity is cited as a major risk factor for fascial wound dehisence and late incisional hernia after major abdominal surgery. The purpose of this study was to prospectively compare two methods of closure of the linea alba after gastric restrictive operations performed for treatment of morbid obesity.
During a 6-year period 229 patients were randomized to have closure of the midline fascia using either a double-stranded #1 PDS suture placed in a continuous fashion or #1 Ethibond suture placed using an interrupted figure-eight technique.
Two of 109 patients who had closure with Ethibond suffered an acute dehiscence of the midline fascia vs no cases of fascial dehiscence in the PDS group. There were no wound infections in either group. There were 20 late incisional hernias (18%) in the Ethibond group vs 11 late hernias (10%) in the PDS group (
P ≤0.04). Mean postoperative follow-up time for all patients was 29.4 months. The cost of suture material and the time required to completely close the linea alba were also calculated for each group. The mean closure time in the Ethibond group was 13.3 vs 9.1 minutes in the PDS group (
P <0.0001). Although the cost per suture pack of #1 PDS was $4.63 vs $1.76 per pack for #1 Ethibond, the mean cost of sutures per patient was $4.81 for PDS vs $11.09 for Ethibond.
We conclude that #1 PDS placed in a continuous fashion provides a more secure and cost-effective closure of the midline fascia in morbidly obese patients than #1 Ethibond placed using an interrupted figure-eight technique.</description><subject>Adult</subject><subject>Anastomosis, Roux-en-Y</subject><subject>Antibiotic Prophylaxis</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Dehiscence</subject><subject>Fascia</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastric Bypass - methods</subject><subject>Gastroplasty - methods</subject><subject>Granuloma, Foreign-Body - etiology</subject><subject>Hernia</subject><subject>Hernia - etiology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Obesity, Morbid - surgery</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Risk factors</subject><subject>Stomach - surgery</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery (general aspects). 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Surgical Wound Dehiscence - etiology</topic><topic>Suture Techniques - adverse effects</topic><topic>Suture Techniques - economics</topic><topic>Sutures</topic><topic>Wound infection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brolin, Robert E.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brolin, Robert E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>1996-10-01</date><risdate>1996</risdate><volume>172</volume><issue>4</issue><spage>328</spage><epage>331</epage><pages>328-331</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Severe obesity is cited as a major risk factor for fascial wound dehisence and late incisional hernia after major abdominal surgery. The purpose of this study was to prospectively compare two methods of closure of the linea alba after gastric restrictive operations performed for treatment of morbid obesity.
During a 6-year period 229 patients were randomized to have closure of the midline fascia using either a double-stranded #1 PDS suture placed in a continuous fashion or #1 Ethibond suture placed using an interrupted figure-eight technique.
Two of 109 patients who had closure with Ethibond suffered an acute dehiscence of the midline fascia vs no cases of fascial dehiscence in the PDS group. There were no wound infections in either group. There were 20 late incisional hernias (18%) in the Ethibond group vs 11 late hernias (10%) in the PDS group (
P ≤0.04). Mean postoperative follow-up time for all patients was 29.4 months. The cost of suture material and the time required to completely close the linea alba were also calculated for each group. The mean closure time in the Ethibond group was 13.3 vs 9.1 minutes in the PDS group (
P <0.0001). Although the cost per suture pack of #1 PDS was $4.63 vs $1.76 per pack for #1 Ethibond, the mean cost of sutures per patient was $4.81 for PDS vs $11.09 for Ethibond.
We conclude that #1 PDS placed in a continuous fashion provides a more secure and cost-effective closure of the midline fascia in morbidly obese patients than #1 Ethibond placed using an interrupted figure-eight technique.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8873523</pmid><doi>10.1016/S0002-9610(96)00194-8</doi><tpages>4</tpages></addata></record> |
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| ispartof | The American journal of surgery, 1996-10, Vol.172 (4), p.328-331 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Adult Anastomosis, Roux-en-Y Antibiotic Prophylaxis Biological and medical sciences Chi-Square Distribution Dehiscence Fascia Female Follow-Up Studies Gastric Bypass - methods Gastroplasty - methods Granuloma, Foreign-Body - etiology Hernia Hernia - etiology Hernias Humans Male Medical sciences Middle Aged Obesity Obesity, Morbid - surgery Patients Prospective Studies Risk factors Stomach - surgery Stomach, duodenum, intestine, rectum, anus Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Surgical Wound Dehiscence - etiology Suture Techniques - adverse effects Suture Techniques - economics Sutures Wound infection |
| title | Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations |
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