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Background: Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods: The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion: This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration: ChiCTR2300073030 (https://www.chictr.org.cn/). Registered on 30 June 2023. [ABSTRACT FROM AUTHOR]

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method. [ABSTRACT FROM AUTHOR]

Abstract Background Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration ChiCTR2300073030 ( https://www.chictr.org.cn/ ). Registered on 30 June 2023.

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.

Aim:Our hypothesis was that the treatment results would be superior to those of other methods in the patient group treated with a single anterior midline approach. The aim of this study was to assess the clinical and radiological results of surgical methods used to treat tibial plateau fractures.Methods:This retrospective study included 60 patients who underwent tibial plateau fracture surgery between 2019 and 2021. The Schatzker fracture classification was used to analyze and compare the association between surgical incisions and clinical and radiological outcomes in terms of complication rate.Results:The study included 60 patients (35 males and 25 females). The mean age of the patients was 44.8 years. The lateral incision is almost always preferred for Schatzker type 1-2-3 fractures, whereas the midline incision is used extensively for type 4-5-6 fractures. Better clinical and radiologic results were observed in Schatzker type 1 and 3 fractures. There were no significant differences in complications between anterior midline single-incision and double-incision surgeries.Conclusion:Tibial plateau fractures require anatomical joint reduction and rigid fixation of fracture fragments. A single anterior midline incision for bicondylar plateau fractures can be safely utilized, although larger patient series studies are needed.

Aim: Our hypothesis was that the treatment results would be superior to those of other methods in the patient group treated with a single anterior midline approach. The aim of this study was to assess the clinical and radiological results of surgical methods used to treat tibial plateau fractures. Methods: This retrospective study included 60 patients who underwent tibial plateau fracture surgery between 2019 and 2021. The Schatzker fracture classification was used to analyze and compare the association between surgical incisions and clinical and radiological outcomes in terms of complication rate. Results: The study included 60 patients (35 males and 25 females). The mean age of the patients was 44.8 years. The lateral incision is almost always preferred for Schatzker type 1-2-3 fractures, whereas the midline incision is used extensively for type 4-5-6 fractures. Better clinical and radiologic results were observed in Schatzker type 1 and 3 fractures. There were no significant differences in complications between anterior midline single-incision and double-incision surgeries. Conclusion: Tibial plateau fractures require anatomical joint reduction and rigid fixation of fracture fragments. A single anterior midline incision for bicondylar plateau fractures can be safely utilized, although larger patient series studies are needed. [ABSTRACT FROM AUTHOR]

Abstract 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.

The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies.

Background: Electrocautery has the advantages of making incisions with less blood loss, and dry and rapid dissection of tissue. Possible postoperative risks associated with electrocautery use are poor wound healing and surgical site infection. Aim and Objectives: To compare diathermy with scalpel in making midline incisions with regard to blood loss, time taken for incision, postoperative pain and wound infection. Material and Methods: Comparative observational study of 100 patients operated on through midline abdominal incision with 50 patients in Group A (the electrocautery group) and remaining 50 patients in Group B (the scalpel group). The dimension of the incision, time taken for making incisions and blood loss were reported. The postoperative pain and wound infection were also monitored. Results: Significant difference was revealed between Groups A and B concerning the mean time for incision per unit area of the wound, 8.26±1.46 and 10.96±1.59 s\cm2 respectively (p

Background: Even if the minimally invasive approach is advancing in pancreatic surgery, the open approach is still the standard for a pancreatoduodenectomy. There are two types of incisions used: the midline incision (MI) and transverse incision (TI). The aim of this study was to compare these two incision types, especially regarding wound complications. Methods: A retrospective review of 399 patients who underwent a pancreatoduodenectomy at the University Hospital Erlangen between 2012 and 2021 was performed. A total of 169 patients with MIs were compared with 230 patients with TIs, with a focus on postoperative fascial dehiscence, postoperative superficial surgical site infection (SSSI) and the occurrence of incisional hernias during follow-up. Results: Postoperative fascial dehiscence, postoperative SSSI and incisional hernias occurred in 3%, 8% and 5% of patients, respectively. Postoperative SSSI and incisional hernias were significantly less frequent in the TI group (SSI: 5% vs. 12%, p = 0.024; incisional hernia: 2% vs. 8%, p = 0.041). A multivariate analysis confirmed the TI type as an independent protective factor for the occurrence of SSSI and incisional hernias (HR 0.45 (95% CI = 0.20–0.99), p = 0.046 and HR 0.18 (95% CI = 0.04–0.92), p = 0.039, respectively). Conclusion: Our data suggest that the transverse incision for pancreatoduodenectomy is associated with reduced wound complications. This finding should be confirmed by a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Myxoglobulosis is a rare form of appendiceal mucocele characterized by mucoid material inside the appendix that resembles fish eggs. It is usually asymptomatic and diagnosed incidentally, but it can also present as a surgical abdomen, which can create a diagnostic dilemma. This case report presents a 37-year-old male patient with features suggestive of acute appendicitis. A computed tomography scan of the abdomen showed features of appendiceal mucocele. The patient underwent appendicectomy through a lower midline incision. The macroscopic finding was myxoglobulosis, and the patient had an uneventful postoperative course. The histopathology report of the appendix confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Abdominal wound dehiscense, or burst abdomen, is a critical postoperative complication necessitating immediate intervention. We present an extremely rare case of left hepatic lobe evisceration through wound dehiscense in a 65-year-old female receiving palliative care for hypopharyngeal squamous cell carcinoma. The patient's midline incision that was performed for feeding jejunostomy tube displayed liver protrusion on Day 14 postoperatively. Surgical exploration revealed a healthy liver, prompting reduction and secondary sutures to prevent complications. Abdominal wound dehiscense risk factors, including advanced age, poor nutrition, and medical illness, contribute to its occurrence. Although guidelines for liver evisceration management are lacking, our case emphasizes proper technique, wound care, and nutritional support to aid the healing process and to ensure a better outcome for the patients. [ABSTRACT FROM AUTHOR]

Purpose: We present the paraspinal approach use for neuromuscular scoliosis with focus on deformity correction, perioperative (≤30 days) morbidity and outcome at a minimal follow-up length of 2 years. Methods: We prospectively collected data of 61 neuromuscular scoliosis patients operated using a paraspinal (Wiltse) approach between 2013 and 2019. We additionally collected data of 104 control cases, operated using a midline approach between 2005 and 2016. Fifteen Wiltse, respectively 37 control patients were excluded due to a short follow-up (<2 years), and 22 controls were excluded secondary to lacking follow-up data. Hence, 46 Wiltse and 45 control patients were compared. Results: Wiltse and control patients had comparable follow-up lengths, demographics, deformity corrections, complication rates, number of levels fused, and intensive care unit and hospital lengths of stay. Wiltse cases had a lower estimated blood loss (535 vs 1187 mL; p-value < 0.001), allogenic transfusion rate (48% vs 96%; p-value < 0.001), and operating time (ORT) (337 vs 428 min; p-value < 0.001) than controls. This was also the case when selecting for patients without pelvic fixation (p-values < 0.001). When selecting the cases with pelvic fixation (20 among 91 cases), only the number of levels fused and the ORT differed significantly according to the approach (p-value <0.015 and <0.041). Conclusion: The paraspinal approach for neuromuscular scoliosis is safe, associated with significant deformity correction, reduced estimated blood loss, and allogenic transfusion rate. These potential benefits still need to be evaluated, especially for cases with pelvic fixation, with further follow-up of larger cohorts. Level of evidence: level III. [ABSTRACT FROM AUTHOR]

Objective: To calculate the frequency of wound dehiscence after midline laparotomies; as well as look into the factors associated with the grave complication. Study Design: Cross Sectional Design. Setting: Department of Surgery, Ayub Teaching Hospital, Abbottabad. Period: May 2019 to Nov 2019. Material & Methods: Data including factors studied and diagnosis of abdominal wound dehiscence were noted on prepared pro forma. Patients were followed and final outcome was assessed. Results: Of these 134 cases, 94 (70.1 %) were male whereas 40 (29.9 %) were female. Mean age was 31.57 ± 11.38 years. Significant association of wound dehiscence with age (p=0.007), residential status (p=0.001), preoperative use of antibiotics (p=0.001), obesity (p=0.002), suture material used (p=0.011) and use of drain (p=0.001) was determined. Wound dehiscence was noted in 23 patients (17.2%). Conclusion: High frequency of wound dehiscence was observed in patients undergoing midline laparotomies during the study. Wound dehiscence was significantly associated with age, residential status, preoperative antibiotics usage, obesity, suture material preferences and drain placement. These complications must be anticipated for early diagnosis and proper management to decrease the burden of related morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Background: Electrocautery has the advantages of making incisions with less blood loss, and dry and rapid dissection of tissue. Possible postoperative risks associated with electrocautery use are poor wound healing and surgical site infection. Aim and Objectives: To compare diathermy with scalpel in making midline incisions with regard to blood loss, time taken for incision, postoperative pain and wound infection. Material and Methods: Comparative observational study of 100 patients operated on through midline abdominal incision with 50 patients in Group A (the electrocautery group) and remaining 50 patients in Group B (the scalpel group). The dimension of the incision, time taken for making incisions and blood loss were reported. The postoperative pain and wound infection were also monitored. Results: Significant difference was revealed between Groups A and B concerning the mean time for incision per unit area of the wound, 8.26±1.46 and 10.96±1.59 s\cm2 respectively (p<0.0001). An average blood loss per unit area of the wound was found to be significantly lower in the electrocautery group; 0.30±0.041 and 1.29±0.22 ml\cm2 respectively (p-value<0.0001). Postoperative pain and surgical site infection were not significantly different between the two groups (p=0.1508 and 1, respectively). Conclusion: Electrocautery is safe in making abdominal incisions when compared to scalpel, and is associated with less blood loss and incision time with comparable postoperative pain and surgical site infection. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. Methods: The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3 cm and small steps of 5 mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. Results: Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17 months (min 4, max 67 months). Conclusion: Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients. [ABSTRACT FROM AUTHOR]

Purpose: Standardization of abdominal wall closure is suggested to improve quality and reduce the risk for late abdominal wall complications. The purpose of this study was to explore the impact of a structured introduction of guidelines for abdominal wall closure on the rates of incisional hernia and wound dehiscence. Methods: All procedures performed via a midline incision in 2010–2011 and 2016–2017 at Capio St Göran's Hospital were identified and assessed for complications and risk factors. Results: Six hundred two procedures were registered in 2010–2011, and 518 in 2016–2017. Four years after the implementation of new guidelines, 93% of procedures were performed using the standardized technique. There was no significant difference in the incidence of incisional hernia or wound dehiscence between the groups. In multivariate Cox proportional hazard analysis, BMI > 25, wound dehiscence, and postoperative wound infection were found to be independent risk factors for incisional hernia (all p < 0.05). In multivariate logistic regression analysis, male gender and chronic obstructive pulmonary disease were risk factors for wound dehiscence (both p < 0.05). Conclusions: The present study failed to show a significant improvement in rates of incisional hernia and wound dehiscence after the introduction of Small Stitch Small Bites. When introducing a new standardized technique for closing the abdomen, education and structural implementation of guidelines may have an impact in the long run. The risk factors identified should be taken into consideration when closing a midline incision to identify patients with high risk. [ABSTRACT FROM AUTHOR]

Purpose: No accepted benchmarks for open pancreaticoduodenectomy (PD) exist. The study assessed the time to functional recovery after open PD and how this could be affected by the magnitude of midline incision (MI). Materials and methods: Prospective snapshot study during 1 year. Time to functional recovery (TtFR) was assessed for the entire cohort. Further analyses were conducted after excluding patients developing a Clavien-Dindo ≥ 2 morbidity and after stratifying for the relative length of MI. Results: The overall median TtFR was 7 days (n = 249), 6 days for uncomplicated patients (n = 124). A short MI (SMI, < 60% of xipho-pubic distance, n = 62) was compared to a long MI (LMI, n = 62) in uncomplicated patients. The choice of a SMI was not affected by technical issues and provided a significantly shorter TtFR (5 vs 6 days, p = 0.002) especially for pain control (4 vs. 5 days, p = 0.048) and oral food intake (5 vs. 6 days, p = 0.001). Conclusion: Functional recovery after open PD with MI is achieved within 1 week from surgery in half of the patients. This should be the appropriate benchmark for comparison with minimally invasive PD. Moreover, PD with a SMI is feasible, safe, and associated with a faster recovery. [ABSTRACT FROM AUTHOR]

Background: Incisional hernia (IH) is a commonly encountered problem even in the era of minimally invasive surgery (MIS). Numerous studies on IH are available in English literature, but there are lack of data from the Eastern part of the world. This study aimed to evaluate the risk factors as well as incidence of IH by analyzing a large cohort collected from a single tertiary center in Korea. Methods: Among a total number of 4276 colorectal cancer patients who underwent a surgical resection from 2006 to 2019 in Korea University Anam Hospital, 2704 patients (2200 laparoscopic and 504 robotic) who met the inclusion criteria were analyzed. IH was confirmed by each patient's diagnosis code registered in the hospital databank based on physical examination and/or computed tomography findings. Clinical data including specimen extraction incision (transverse or vertical midline) were compared between IH group and no IH group. Risk factors of developing IH were assessed by utilizing univariable and multivariable analyses. Results: During the median follow-up of 41 months, 73 patients (2.7%) developed IH. Midline incision group (n = 1472) had a higher incidence of IH than that of transverse incision group (n = 1232) (3.5% vs. 1.7%, p = 0.003). The univariable analysis revealed that the risk factors of developing IH were old age, female gender, obesity, co-morbid cardiovascular disease, transverse incision for specimen extraction, and perioperative bleeding requiring transfusion. However, on multivariable analysis, specimen extraction site was not significant in developing IH and transfusion requirement was the strongest risk factor. Conclusions: IH development after MIS is uncommon in Korean patients. Multivariable analysis suggests that specimen extraction site can be flexibly chosen between midline and transverse incisions, with little concern about risk of developing IH. Careful efforts are required to minimize operative bleeding because blood transfusion is a strong risk factor for developing IH. [ABSTRACT FROM AUTHOR]

Background The thoracic epidural analgesia (TEA) is considered as a standard technique for postoperative pain relief in major abdominal surgeries, but sometimes, it is contraindicated or complicated. Rectus-sheath block (RSB) bilaterally has developed recently to offer analgesia in these operations. This study was designed to evaluate the promising RSB as a suitable alternative to TEA in major operations for abdominal cancers through a midline incision. Patients and methods The current clinical trial that had been performed on American Society of Anesthesiologists I, II, and III patients underwent major operations for abdominal cancers through a midline incision, and randomly allocated into either the TEA group: received TEA with bupivacaine+fentanyl or RSB group: received RSB with bupivacaine+fentanyl bilaterally. The primary outcome was the cumulative intravenous (IV) fentanyl doses consumed through the postoperative 24 h. The secondary outcomes were the patients' number who needed analgesia, the duration spent till the first analgesic request, visual analog score with rest and cough, and any complications related to either the block techniques or drugs. Results Cumulative IV fentanyl consumed and the titration doses of IV fentanyl during the postoperative 24 h, the time to the first request of fentanyl, number of patients who needed analgesia, and visual analog score with rest and cough at the time points of the study, all did not show any statistical significant difference between both groups. The RSB group recorded significant shorter time to ambulation compared with the TEA group. Sedation scores were comparable in both groups at all time points of the trial. Both groups were comparable regarding the incidence of fentanyl-associated side effects, time to passing flatus, and patient-satisfaction score. Conclusion RSB could be used as an efficient alternative to TEA, especially whenever the latter is contraindicated in patients subjected to major abdominal surgeries with midline incision. [ABSTRACT FROM AUTHOR]

Background: Postoperative wound site complications are a significant source of morbidity after midline laparotomy. The study's objectives were to compare the two suture patterns for fascial closure in midline abdominal wounds and their effect on postoperative wound site complications. Materials and Methods: Over 4 years, the prospective comparative study was conducted at the Government Medical College Hospital, Srinagar. All the patients ≥18 years and ≤70 years of age underwent midline laparotomy for various indications were included. Patients were randomized to two groups using computer-generated numbers based on closure techniques. Group A; Large Tissue Bite closure (10 mm from the wound edge and 10 mm apart and Group B; Small Tissue Bite closure (5-7 mm from the wound edge and 5-7 mm apart). Effect of age, sex, body mass index (BMI), albumin, and suture bite on postoperative complications were analyzed. Results: Among 324 patients who met the inclusion criteria, the mean age was 39.17 years, 84.56% were male with a Male: Female ratio of 5.48. Two hundred and two (62.35%) patients had large tissue bite closure, and 122 (37.75%) had small bite closure. There was no statistically significant difference between the two groups concerning age, sex, albumin levels, BMI, and type of surgery. About 35.64% of patients in the large tissue bite closure group and 19.67% patients in small bite closure developed surgical site infection (SSI) (P = 0.002). The difference in wound dehiscence between the two groups (15.84% vs. 7.38%) was statistically insignificant (P = 0.29). In midline laparotomy closure, the small bites technique results in significantly less incisional hernias than the large bites technique (P = 0.00001). None of our patients expired during the study period. Conclusion: The small bite technique substantially reduces SSIs, wound dehiscence, and incisional hernia. The accident-emergency and general surgery residents, in particular, should be made familiar with this technique to avoid postoperative wound site complications and improve the quality of postoperative life. [ABSTRACT FROM AUTHOR]

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used. Methods: A descriptive study was carried out from October 2015 to May 2016. Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds. Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital.

Purpose: Advancements in gastrointestinal surgery have directed attention toward optimizing recovery, including through the use of feeding methods that reduce prolonged postoperative hospital stays, complications, and mortality, among other undesirable outcomes. This study's primary goals were to identify current peer-reviewed literature reporting the postoperative outcomes of elective bowel surgery and to evaluate the clinical evidence of patients' tolerance to oral feeding following elective bowel surgery., Methods: An exhaustive literature search was conducted via PubMed and Scopus. The search results were screened for potential articles, and articles were assessed for eligibility based on prespecified eligibility criteria. The data were synthesized, and the results were reported and discussed thematically., Results: The database search yielded 1,667 articles, from which 18 randomized controlled trials were chosen for inclusion in this study. This study included 874 early oral feeding (EOF) patients, 865 traditional oral feeding patients, and 91 patients whose postoperative care was unspecified. Data synthesis was done, and meta-analyses were conducted. The results showed that EOF patients required a significantly shorter time to tolerate a solid diet and had shorter hospital stays. In addition, bowel function was restored earlier in EOF groups., Conclusion: The results show good tolerance to EOF, shorter hospitalizations, and faster restoration of bowel function, suggesting that EOF after elective bowel surgery is relatively safe. However, further studies with similar baseline conditions should be conducted to verify these results.

Aim: The aim of this study was to compare postoperative effects of closed incision negative pressure wound therapy with conventional dressing in emergency laparotomy. Materials and methods: This study was conducted from 1st November 2018 until 31st March 2020 in ABVIMS & Dr. R.M.L. Hospital, New Delhi. Potential candidates for this study were patients aged 18 years or older, who were admitted as emergency surgical cases and underwent emergency laparotomy by midline incision. Fifty patients were randomly allotted to either group A (25 patients) or group B (25 patients). In patients from group A, a closed incision negative pressure wound therapy (ciNPWT) was applied on the closed midline wound after an exploratory laparotomy was performed. Patients from group B received standard dry gauze dressing. Results: The mean ages of patients in group A and group B were 46.76 ± 12.20 and 41.96 ± 8.33 years, respectively (P value -- 0.11). Although wound infections were present in 12% of cases in group A and 32% in group B, this difference was found to be statistically non-significant (P value -- 0.08). Similarly, seroma formation and wound dehiscence were observed less frequently in group A as compared to group B but this also did not reach statistical significance (P values 0.55 and 0.38, respectively). The frequency of dressing change was 1-2 times per week in 92% of cases in group A and 3-4 times per week in 68% of cases in group B. The mean time between dressing changes was 1.24 ± 0.72 per week and 4.28 ± 1.90 per week for groups A and B, respectively (P value < 0.001). There was no significant (P > 0.05) difference in terms of the duration of hospital stay between group A (mean hospital stay 8.20 ± 2.34 days) and group B (mean hospital stay 8.21 ± 3.37 days). Conclusion: Closed incision negative pressure wound therapy has no advantages over conventional dressing in terms of postoperative complications and duration of hospital stay. However, it significantly reduces the required frequency of dressing change, therefore decreasing both the mental stress experienced by patients and the burden on healthcare workers associated with daily dressing changes. [ABSTRACT FROM AUTHOR]

Background Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy–partial facetectomy, and to evaluate mid-term surgical outcomes. Methods 107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests. Result 58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes. Conclusions The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability [ABSTRACT FROM AUTHOR]

Incisional hernia is a well-known complication following abdominal surgery. A frequently performed abdominal operative procedure is cesarean section. In 2015 the median cesarean section rate in Europe was 27 % with rates up to 57 % when looking at individual countries, and the rates of cesarean sections increased with 4 % in Europe from 2010 to 2015. Nonetheless, the occurrence of incisional hernia subsequent to cesarean sections is uncertain. The aim of this study was to investigate the reported occurrence of incisional hernia after cesarean section. We included original studies with women who had given birth at least once through a cesarean section. For studies to be eligible for inclusion, a minimum follow-up period of six months as well as a population of ten or more included patients were required. The primary outcome was occurrence of incisional hernia after cesarean section. The secondary outcomes were frequency of subsequent hernia operations, and if the hernia occurrence differed between midline and lower transverse incision, and between acute and elective cesarean section. Three databases were systematically searched: PubMed, Embase, and the Cochrane Library. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guideline (PRISMA) and registered with the international prospective register of systematic reviews (PROSPERO) (registration number: CRD42019129998). A total of 2170 potentially relevant studies were identified, and of these 28 studies were identified for full text screening. Five studies met the inclusion criteria comprising 275,878 women with a previous cesarean section. The studies reported an occurrence of incisional hernia subsequent to cesarean section between 0.0-5.6 % with a follow-up time ranging from six months to ten years. Very few known risk factors for incisional hernia development were reported in the included studies. Overall, we found a low risk of incisional hernia subsequent to cesarean sections, even after a long follow-up period. Based on the included studies it was not feasible to estimate the occurrence of incisional hernia in different types of incisions, whether the urgency of the cesarean section affected the incisional hernia development, or to estimate the frequency of subsequent hernia repair. Further well-designed studies are therefore warranted. [ABSTRACT FROM AUTHOR]

Purpose: In severe hypospadias staged repair is commonly used and it is regarded as feasible, safe, and durable. In this article we want to describe the results of a modification of the staged repair: a midline incision of the graft during the second stage.Materials and Methods: This is a consecutive single team (2 surgeons) retrospective series. Between 2014 and 2017, 250 patients underwent hypospadias repair, among them 35 patients that had primary staged hypospadias surgery with completed first and second stage repair. 24 (68.6%) cases received a preputial skin graft and 11 (31.4%) buccal mucosa graft. Median age at first stage was 1.5 (0.5–22.1) years, mean time between first and second stage operation was 0.72 (0.4–1.76) years. Follow up rate was 100%, mean follow up period was 1.50 (0.4–3.8) years.Results: The total complication rate was 22.9%. In buccal mucosa repair the complication rate was 36.4% and in preputial graft repair the complication rate was 16.7%, respectively. In 23 patients (65.7%) during second stage urethroplasty a midline incision was performed (8 glandular graft, 15 penile graft, 6 at level of urethral opening). Complication rate in non-incised urethroplasty was 8.3%, in incision at glandular level 37.5%, in incision at penile level 13.3% and in incision at urethral opening 16.7%, respectively.Conclusions: Two stage repair is the method of choice in the correction of severe hypospadias. In selected cases a midline incision of the graft is feasible and can be applied if needed. Randomized studies will be needed to evaluate the true benefit of incising the graft.

Introduction: Incisional hernia is a common and costly complication following abdominal surgery. The incidence of incisional hernia after gynecological surgery is not as well studied as that after general surgery.Materials and Methods: The Swedish National Quality Register for Gynecological Surgery (GynOp) collects preoperative, intraoperative, and postoperative information regarding gynecological surgery. Data were extracted from 2006 to 2014. The National Patient Register (NPR) contains physicians' data from both public and private hospitals. Univariate and multivariate Cox proportional hazard analyzes were performed on risk factors.Results: Between 2006 and 2014, 39,312 women undergoing open surgery were registered in GynOp. The NPR recorded 526 patients who were diagnosed with or had undergone surgery for incisional hernia. The mean follow-up was 2.8 years. Five years after surgery the cumulative incidence of incisional hernias was 2.0% (95% confidence interval 1.8-2.2%). In multivariate Cox proportional hazard analysis obesity (BMI > 30), age > 60 years, midline incision, smoking, kidney, liver, and pulmonary disease were found to predict an increased risk for incisional hernias (all p < 0.05).Conclusions: There is much to be gained if the patient can cease smoking and lose weight before undergoing abdominal surgery. The Pfannenstiel incision results in fewer incisional hernias and should be considered whenever possible. [ABSTRACT FROM AUTHOR]

Objective: Femoral hernias constantly present as incarceration or strangulation and require emergency surgery. Incarcerated and strangulated femoral hernia repair remains challenging and controversial. The aim of our study was to analyze the efficacy of preperitoneal tension-free hernioplasty via lower abdominal midline incision for incarcerated and strangulated femoral hernia.Methods: Data of 47 patients who underwent emergency surgery for incarcerated or strangulated femoral hernias from January 2009 to December 2017 were retrospectively analyzed. According to the surgical incisions, they were divided into two groups: the observation group (21 cases) had a lower abdominal midline incision, and the control group (26 cases) had a traditional inguinal incision. General data of patients, intraoperative findings, operative time and postoperative complications were compared.Results: Patient characteristics showed that the two groups were comparable.15 cases (31.9%) underwent intestinal resection, and 32 cases (68.1%) underwent first-stage tension-free repair in total. The rate of first-stage tension-free hernioplasty was significantly higher in the observation group (18/21, 85.7% vs 14/26 53.8%, P = 0.020). No additional incision was required in the observation group, while six cases of the control group (23.1%) had an additional incision for intestinal resection and anastomosis (P = 0.026). Mean operative time (53.6 ± 24.7 min vs 77.9 ± 36.5 min, P = 0.012) and the length of hospital stay (6.3 ± 4.2 days vs 10.3 ± 6.9 days, P = 0.020) were significantly shorter in the observation group. The time of return to normal physical activity resulted significantly reduced compared to the control group (9.2 ± 4.1 days vs 13.3 ± 6.6 days, P = 0.017). The total incidence of postoperative complication (including chronic pain, foreign body sensation, hernia recurrence, wound infection and seroma/hematomas) in the observation group was lower (14.3% vs 42.3% P = 0.037). There were two recurrences in the control group. No mesh-related infection and no mortalities in two groups.Conclusions: Midline preperitoneal approach for incarcerated and strangulated femoral hernia is a convenient and effective technique. It can improve the rate of first-stage tension-free repair of incarcerated femoral hernia and allow intestinal resection through the same incision, and with lower rate of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Access for right hemicolectomy can be gained by median or transverse incision laparotomy. It is not known whether these routes differ with regard to short-term postoperative outcomes.Methods: Patients in the DGAV StuDoQ|ColonCancer registry who underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) were compared regarding Clavien-Dindo classification (CDC) complications (primary endpoint) as well as specific postoperative complications, operation time, length of stay, and MTL30 status (secondary endpoints).Results: A total of 3700 StuDoQ registry patients underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) without additional interventions. The median and transverse access routes did not differ regarding CDC complication rates (CDC > =3a: 13.1% vs. 12.6%; p = 0.90). However, univariate and multivariate analyses showed that operation times (OR 0.71, 95% CI 0.62-0.81; p < 0.001), length of stay (OR 0.69, 95% CI 0.6-079; p < 0.001), and MTL30 (OR 0.7, 95% CI 0.61-0.81, p < 0.001) were significantly reduced in the transverse laparotomy group.Conclusions: For oncological right hemicolectomy, open transverse upper abdominal laparotomy appears to be superior to median laparotomy in short-term course. [ABSTRACT FROM AUTHOR]

Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.