Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections

Vries, Hilbert S. de; Verhaak, T.; Boxtel, Tiemen H. van; Heuvel, Willem‐Jan van den; Teixeira, M. B.; Heisterkamp, Joos; Zimmerman, D. D. E.

doi:10.1007/s10029-019-01995-9

Cited by 18 publications

(17 citation statements)

References 19 publications

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“…Dayama in a study of 1792 participants, reported a deep SSI rate of 2.3% in the complete closure cohort and 1.2% in the incision skin open group (p = 0.15) [33]. In his 88-patient study of the small bites technique versus large bites fascial closure, de Vries found that 35% developed SSIs using the small bites technique compared to 57% with the large bites technique [34]. Frazee then examined 49 patients as part of an RCT and showed a 4.2% rate of SSI for incisional NPWT and skin open compared to 8% for incisional NPWT and skin closed [35].…”

Section: Bundle Element Resultsmentioning

confidence: 99%

“…Our technical closure group showed a non-significant reduction of 15% in SSI rates (3.55%, 54/1521) compared to the control group (8.64%, 54/625) (RR = 0.85; CI, 0.57-1.26; p = 0.41) (Figure 4). There was a moderate level of heterogeneity between trials (I 2 = 42%) [33][34][35]38,40].…”

Section: Discussionmentioning

confidence: 98%

“…DeVries found that small bite technique was superior to continuous fascial closure, but the difference detected proved insignificant [34]. Peponis found continuous fascial closure compared to interrupted fascial closure had a non-significant reduction in SSI from 16.2% to 12.2% (RR = 1.33; CI, 0.44-4.00; p = 0.61)) [38].…”

Section: Discussionmentioning

confidence: 99%

“…Following leave-one-out sensitivity analysis, it was shown after leaving out Dayama's study that our technical closure bundle became significant and showing a reduction in SSI of 36% (RR = 0.64; CI, 0.41-0.99; p = 0.05) ( Figure 5). The meta-analysis of the five grouped abdominal wall closure studies are limited by their small number and heterogenicity [33][34][35]38,40]. Dayama examined complete skin closure versus skin-open [33].…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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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.

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Section: Bundle Element Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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“…Therefore, the implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections in this study. 13 In the study performed by Gokani et al on the economic evaluation of small bite sutures versus large bite sutures in the closure of midline laparotomies in the United Kingdom National Health Service it was concluded that small bites technique reduced the incidence of SSI by 15%. 14 This study also depicted increased incidence of SSI in large bite group.…”

Section: Wound Infectionmentioning

confidence: 99%

Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

et al. 2020

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Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.

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Introduction of Small Stitch Small Bite technique: a retrospective long-term follow-up

Söderbäck

Masood

Leo

et al. 2022

Langenbecks Arch Surg

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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.

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Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections

Cited by 18 publications

References 19 publications

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

Introduction of Small Stitch Small Bite technique: a retrospective long-term follow-up

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