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>Journals >Cirujano General >Year 2005, Issue 4


Miranda MR
Mass closure of the abdominal wall
Cir Gen 2005; 27 (4)

Language: Español
References: 20
Page: 318-323
PDF: 4. Kb.


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ABSTRACT

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.


Key words: Laparotomy, laparorrhaphy, incisional hernia.


REFERENCIAS

  1. Abel AL, Hunt AH. Stainless steel wire for closing abdominal incisions and for repair of herniae. Br Med J 1948; 2: 379-82.

  2. Adamsons RJ, Musco F, Enquist IF. The chemical dimensions of a healing incision. Surg Gynecol Obstet 1966; 123: 515-21.

  3. Carlson MA. Absorbable versus nonabsorbable suture for laparotomy closure. In: Schumpelick V, Kingsnorth AN, ed. Incisional hernia. Berlin: Springer-Verlag; 1999: 235-9.

  4. Carlson MA. Acute wound failure. In: Schumpelick V, Kingsnorth AN, ed. Incisional hernia. Berlin: Springer-Verlag; 1999: 101-9.

  5. Dudley HA. Layered and mass closure of the abdominal wall. A theoretical and experimental analysis. Br J Surg 1970; 57: 664-7.

  6. Ellis H, Heddler R. Does the peritoneum need to be closed at laparotomy? Br J Surg 1977; 64: 733-6.

  7. Forrester JC. Sutures and wound repair. In: Hunt TK, ed. Wound healing and wound infection, Theory and Surgical Practice, New York: Appleton-Century-Crofts; 1980: 194-207.

  8. Gislason H. Closure of the abdomen in acute wound failure. In: Schumpelick V, Kingsnorth AN, ed. Incisional hernia. Berlin: Springer-Verlag; 1999: 253-7.

  9. Gislason H. Experience with continuous absorbable suture for laparotomy closure. In: Schumpelick V, Kingsnorth AN, ed. Incisional hernia. Berlin: Springer-Verlag; 1999: 240-5.

  10. Haxton H. The influence of suture materials and methods on the healing of abdominal wounds. Br J Surg 1965; 52: 372-5.

  11. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 2000; 231: 436-42.

  12. Israelsson LA. Continuous closure of laparotomy incision. In: Schumpelick V, Kingsnorth AN, ed. Incisional hernia. Berlin: Springer-Verlag; 1999: 246-52.

  13. Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg 1976; 63: 873-6.

  14. Melo RM, Cozadi AO, Fleury MC. Laparorrafia em massa: fio em alça dupla. Rev Col Bras Cir 1993; 20: 113-6.

  15. Melo RM, Gazél ASC, Cozadi AO. Avaliação do tempo de fechamento e da ocorrência de deiscência total entre dois métodos de laparorrafia. Rev Col Bras Cir 1989; 16: 256-8.

  16. Melo RM, Martins JL. Estudo comparativo entre as suturas total e subtotal da parede abdominal ventral do rato: resultados tardios no estrato músculo-aponeurótico à microscopia óptica. Rev Col Bras Cir 1995; 22: 247-52.

  17. Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg 2001; 67: 421-6.

  18. Tera H, Aberg C. Tissue strength of structures involved in musculo-aponeurotic layer sutures in laparotomy incisions. Acta Chir Scand 1976; 142: 349-55.

  19. van ’t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 2002; 89: 1350-6.

  20. Wadstrom J, Gerdin B. Closure of the abdominal wall; how and why? Clinical review. Acta Chir Scand 1990; 156: 75-82.






>Journals >Cirujano General >Year 2005, Issue 4
 

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