Diagnosis and treatment of anterior abdominal wall ligature fistulas

Abstract

AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.