Visceral and parietal suture in abdominal surgery

Goligher, J. C.

doi:10.1016/0002-9610(76)90086-6

Cited by 21 publications

(5 citation statements)

References 21 publications

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“…Jenkins (1976), who is the principal proponent of the mass-closure technique in this country, records a remarkable series of 1505 closures with only one burst abdomen, and excellent results are also reported by Bentley et al (1978), Goligher (1976) and Kirk (1972). Martyak & Curtis (1976) had neither hernias nor burst abdomens in 280 midline wounds closed with all-layer continuous nylon.…”

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confidence: 87%

Closure of the Abdominal Wound

Ellis

Heddle

1979

J R Soc Med

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The ideal method of abdominal wound closure remains to be discovered. This should be technically so simple that the results are just as good in the hands of the trainee as in those of the surgical master; it should be free from the complications of burst abdomen, incisional hernia and persistent sinuses; it should be comfortable to the patient and it should result in a reasonably aesthetic scar. Since 1975, we have been engaged in a series of trials of different techniques of closure of abdominal incisions and, although we can report improvement in our results, these are still far from ideal.Our first investigation was into the importance of suture of the peritoneal layer. This is stressed in the standard surgical textbooks and yet every surgeon encounters the situation in the straining patient with poor tissues where the peritoneal stitches tear through. Moreover, some surgeons defy the rules and leave the peritoneum unsutured without apparent disaster and, in our own animal studies, spread over many years (Ellis 1962(Ellis , 1978, we know that raw peritoneal defects heal rapidly and smoothly.Over There were 4 burst abdomens (2.5%) in the two-layer group, and 5 (3%) in the one-layer group. To date, 8 patients (5%) in the two-layer group and 14 (8.5%) in the one-layer group have developed an incisional hernia. There is no statistical difference between these two groups.In searching for the causes of wound failure in this series, jaundice at the time of laparotomy was found to be of particular importance. There were 21 patients who were jaundiced at the time of surgery, among whom 3 developed a burst abdomen and 4 an incisional hernia. Male sex, closure performed by junior staff, obesity, postoperative chest complications, postoperative distension and wound infection all produced a relatively high incidence of wound failure, but these failed to reach statistical significance. We have previously shown, in rats rendered jaundiced by ligation of the common bile duct, that the healing of the abdominal incision, as well as of visceral wounds, is seriously impaired (Bayer & Ellis 1976).Dismayed by the high incidence of burst abdomen and incisional hernia in patients subjected to layered closure by the technique which is probably that most commonly employed in the United Kingdom, we were naturally attracted by the theoretical arguments supporting the value of non-absorbable sutures in a mass-closure technique which includes all layers of the abdominal wall apart from skin and which incorporates wide bites of tissue on either side of the line of incision, placed close together and under no-tension. Jenkins (1976), who is the principal proponent of the mass-closure technique in this country, records a remarkable series 1

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confidence: 87%

Closure of the Abdominal Wound

Ellis

Heddle

1979

J R Soc Med

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“…A SOURCE of continuing controversy in abdominal surgery is the technique of intestinal suture (Goligher, 1975(Goligher, , 1976. Opinion is divided as to the relative merits of inverting, end-on or everting apposition of the cut edges of intestine, of one or two layers of sutures for this purpose and of different suture materials, including metallic staples introduced by suture machines (Fain et al, 1975;Ferguson and Houston, 1975).…”

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A controlled comparison of one- and two-layer techniques of suture for high and low colorectal anastomoses

Goligher

Lee

Simpkins

et al. 1977

British Journal of Surgery

116

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A controlled trial of one- and two-layer inverting techniques of sutures for the contruction of high and low colorectal anastomoses was conducted on 137 patients, the integrity of the suture lines being assessed clinically and by routine radiological examination after a small Gastrografin enema. A clinical diagnosis of anastomotic leakage was made in 9 patients (or perhaps more accurately in 5 only), but subclinical dehiscence was demonstrated radiologically in a further 39 patients (or perhaps 43). There was a slightly greater incidence of dehiscence after the one-layer technique of suture for both high and low anterior resection.

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“…He also noted that the technique of mass closure with nylon significantly reduced the rate of wound dehiscence. In paramedian laparotomies, Goligher 7 in 1975 reported one burst abdomen and no incisional hernias among 108 cases, using all coats interrupted steel wire sutures. Martyak and Curtis 8 in 1976 closed 280 midline wounds with all coats continuous nylon, again without a single wound dehiscence and a similar finding was reported by Leaper 9 in 1977 in 120 laparotomies subjected to mass closure using steel wire.…”

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confidence: 99%

A Comparative Study of Single Layer Closure and Conventional Layered Closure of Laparotomy Wounds

Sreeharsha¹

2013

jemds

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HOW TO CITE THIS ARTICLE:Sreeharsha ABSTRACT: OBJECTIVE:To compare the techniques of single layer closure and conventional layered closure of laparotomy wounds on the basis of operative time and post-operative complications. METHODS: Prospective randomized study of 100 patients who underwent laparotomy in a tertiary care hospital in Karnataka, for abdominal surgical problems needing either emergency or elective surgery. Out of these 100 patients, 50 patients underwent laparotomy wound closure by single layer closure technique and the rest 50 patients by conventional layered closure technique. Time taken for closure of laparotomy wound was noted and patients were followed up post-operatively for any wound complications like seroma, wound infection, wound gaping, burst abdomen and incisional hernia. RESULTS: The mean time taken for closure of laparotomy wounds by single layer closure technique was 19 minutes and by conventional layered closure technique was 27 minutes. There was a difference of 8 minutes which was statistically significant (p=0.001). In the postoperative period, in patients who underwent single layer closure, totally 9 patients (18%) had post operative complications. In that 3 patients (6%) had seroma, 3 patients (6%) had wound infection, 2 patients (4%) had wound gaping, 1 patient (2%) had burst abdomen and none had incisional hernia. In patients who underwent conventional layered closure, totally 15 patients (30%) had post operative complications. In that 5 patients (10%) had seroma, 4 patients (8%) had wound infection, 3 patients (6%) had wound gaping, 2 patients (4%) had burst abdomen and 1 patient (2%) had incisional hernia. CONCLUSION: Laparotomy wound closure with single layer closure technique is better than the conventional layered closure technique in terms of decreased operative time and also decreased postoperative complications.

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Visceral and parietal suture in abdominal surgery

Cited by 21 publications

References 21 publications

Closure of the Abdominal Wound

Closure of the Abdominal Wound

A controlled comparison of one- and two-layer techniques of suture for high and low colorectal anastomoses

A Comparative Study of Single Layer Closure and Conventional Layered Closure of Laparotomy Wounds

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