ABSTRACT
Objective: To compare the impact of interrupted braided suture to continuous monofilament sutures on the development of abdominal wound dehiscence in high risk patients
Methods: Clinical judgment and the Rotterdam risk score of abdominal wound dehiscence were used to identify 140 patients at high risk for abdominal wound dehiscence. Seventy high-risk patients who had their laparotomy wounds closed by interrupted braided suture [intervention group] were compared to a similar group of patients who had continuous monofilament suture closure [control group]. Demographic, clinical and operative data of both groups were compared. The primary outcome was the occurrence of wound dehiscence either partial or complete. Secondary outcomes include development of wound infection and the 30-day mortality rate. The mean follow up period was 3 months [range 1-6 months]
Results: There were 78 males and 62 females with a mean age of 62.2+/-13.0 years. Both groups were equivalent in terms of demographics, Rotterdam risk score, type of surgery and surgical incision. Wound dehiscence occurred equally in both groups [24.3 in control vs 22.9% in intervention group, p value 0.842] but evisceration was significantly reduced by the use of interrupted sutures [4.3 vs 14.3%, p value 0.042]. The method of closure has no significant impact on infection and early mortality
Conclusion: Although method of closure did not affect the overall incidence of wound dehiscence, interrupted braided sutures significantly reduced occurrence of evisceration. This reduced the need for urgent revisional surgery but did not affect the early mortality rate. A larger randomized control trial with a longer follow up period is advised
ABSTRACT
Objective: To present our experience in the first 100 live liver-donors done at King Hussein Medical Center with emphasis on donor postoperative complications and possible risk factors predisposing to complications
Methods: Over a period of 11 years 100 live-liver donors underwent surgery. Demographic, clinical and perioperative data of these donors were collected. Postoperative complications were registered and classified according to the Clavien-Dindo classification. Statistical analysis was used to identify potential patients' or grafts' factors associated with complications
Results: The mean age of donors was 30.71+/-7.17 and mean body mass index was 24.50+/- 2.56. Three procedures were abandoned after laparotomy. 71 underwent right hepatectomy, 12 right hepatectomy with inclusion of middle hepatic vein, 11 left hepatectomy and 3 left lateral sectorectomy. The overall complication rate was 36% with most of these being minor grade I and II [26%] complications. 9 patients developed grade III complications while one patient had grade IVa. The mortality rate was zero. Older age and higher body mass index were identified as potential risk factors for complications. Gender, graft type, estimated future liver remnant, inclusion of middle hepatic vein and preoperative biochemical profile were not found in this study to correlate with occurrence of complication
Conclusion: Strict donor selection and meticulous surgical procedure remain the only modifiable factors in donor hepatectomy. Continuous transparent clinical audit is mandatory to identify potentially preventable adverse outcomes