Background:Surgical site infection(SSI)is the most common complication after stoma closure and is particularly common in obese patients.To reduce the incidence of SSI,various skin closure techniques have been proposed...Background:Surgical site infection(SSI)is the most common complication after stoma closure and is particularly common in obese patients.To reduce the incidence of SSI,various skin closure techniques have been proposed;however,the best technique is still under debate.The purpose of this study was to explore the effectiveness of subcutaneous vacuum drains(SVDs)after two surgical suture techniques following stoma reversal in obese patients. Methods:Data from 190 obese patients with rectal cancer who underwent stoma reversal for enterostomy between February 2012 and April 2023 at Jinxiang Hospital Affiliated to Jining Medical University were retrospectively analyzed.These patients were divided into two groups:gunsight suture(GS)with SVD and primary linear suture(PLS)with SVD.The GS group and PLS group included 90 and 100 patients,respectively.The clinical characteristics and short-term outcomes were compared between the two groups.Postoperative pain scores were analyzed using a generalized estimation equation. Results:Surgery was successfully performed in both groups.The rate of SSI in the GS group was significantly lower than that in the PLS group(2.2%vs 9.0%,P=0.046).Patients in the GS group had a significantly shorter wound healing time than did patients in the PLS group,as well as a significantly shorter postoperative fasting time(P<0.05).No significant differences were found between the groups in terms of the postoperative hospital stay,operative time,and estimated blood loss(P>0.05).The results of the generalized estimation equation analysis showed that the GS group had significantly lower pain scores at 12,24,48,and 72 h after surgery than the PLS group(P<0.05).Moreover,the GS group showed significantly better alleviation of wound pain between 12 and 72 h after surgery(P<0.05). Conclusions:The GS technique with SVD may be recommended for wound closure of a nonfunctioning stoma in obese patients.展开更多
Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in ...Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.展开更多
基金supported by the New Technology and New Project of Jinxiang Hospital Affiliated to Jining Medical University(No.JY2021022).
文摘Background:Surgical site infection(SSI)is the most common complication after stoma closure and is particularly common in obese patients.To reduce the incidence of SSI,various skin closure techniques have been proposed;however,the best technique is still under debate.The purpose of this study was to explore the effectiveness of subcutaneous vacuum drains(SVDs)after two surgical suture techniques following stoma reversal in obese patients. Methods:Data from 190 obese patients with rectal cancer who underwent stoma reversal for enterostomy between February 2012 and April 2023 at Jinxiang Hospital Affiliated to Jining Medical University were retrospectively analyzed.These patients were divided into two groups:gunsight suture(GS)with SVD and primary linear suture(PLS)with SVD.The GS group and PLS group included 90 and 100 patients,respectively.The clinical characteristics and short-term outcomes were compared between the two groups.Postoperative pain scores were analyzed using a generalized estimation equation. Results:Surgery was successfully performed in both groups.The rate of SSI in the GS group was significantly lower than that in the PLS group(2.2%vs 9.0%,P=0.046).Patients in the GS group had a significantly shorter wound healing time than did patients in the PLS group,as well as a significantly shorter postoperative fasting time(P<0.05).No significant differences were found between the groups in terms of the postoperative hospital stay,operative time,and estimated blood loss(P>0.05).The results of the generalized estimation equation analysis showed that the GS group had significantly lower pain scores at 12,24,48,and 72 h after surgery than the PLS group(P<0.05).Moreover,the GS group showed significantly better alleviation of wound pain between 12 and 72 h after surgery(P<0.05). Conclusions:The GS technique with SVD may be recommended for wound closure of a nonfunctioning stoma in obese patients.
文摘Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.
