>Year 2005, Issue 4
Mass closure of the abdominal wall
Cir Gen 2005; 27 (4)
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Introduction:The method of mass closure of laparotomies is described, which has shown a lower index of dehiscences and of incisional hernias.
Material and methods:A review of 14 references and 4 chapters of surgery books was made, discussing at the end the experience of the author with the described method.
Results:The midline incision continues to be the most used to perform a laparotomy. Its deficient closure can later on become manifested as a total (eventration) or partial (incisional hernia) dehiscence. The factors involved in the failure of adequate closure are technical and are associated to aggregated pathologies. The closure of these incisions with the technique called “in mass” (continuous suture that includes all the muscular-aponeurotic layers) avoids placing sutures in the margins of the wound, site of the inflammatory processes and collagenolysis that favor tissue tearing. Besides, it produces less tension along the whole wound. It is accomplished fast, consumes less suture material and decreases the possibility of infections. In a 15-years period we have performed 1,017 mid primary laparotomies with mass closure, having had only 2.5% of wound infections and 0.1% of dehiscences.
Conclusion:We describe the mass closure used in laparotomies, emphasizing its advantages together with its theoretical bases, which can be extrapolated to all types of approaches to the abdominal cavity.
||Laparotomy, laparorrhaphy, incisional hernia.
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>Year 2005, Issue 4