Factors affecting post-operative laparotomy wound complications.

Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative technique, post-operative wound problems continue to be a major threat. Clean sound healing of laparotomy wound after any intra-abdominal procedure is a cardinal index of good surgical repair. Post- operative wound problems delays recovery and often increase stay and may produce lasting sequel and require extra resources for investigations, management and nursing care, therefore its prevention is relevant to quality patient care, therefore its prevention is relevant to quality patient care.Post-operative wound problems seldom causes death, yet it does prove to be an economic burden on patient and on health system and induce psychological trauma to the surgeon as it robs his hours of dedicated work on operating table and good carrier. Considering wound problems is quite common in developing countries like India the present study was taken up to find out the incidence of Post-operative wound problems and factors that influence its occurrence. Present study aimed to discover the sound, ideal method for the abdominal wound closure with regard to the problems associated with laparotomy wound.

Study of pre-operative and post-operative variables for incisional hernia repair by open and laparoscopic technique.

Background: Incisional hernia is protrusion of part or whole of abdominal viscus through the weakness in layers of anterior wall in the scar of previous operation. The major predisposing factors being post operative wound infection or hematoma. This incidence increases in the presence of adverse factors (local and systemic) such as wound infection, obesity, hypoproteinemia. In all suture repair techniques the tissues are under tension and this increase the risk of ischemia, suture cut out and repair failure. The studies showed that the complication seen in open incisional hernia repair is seroma, hematoma, wound infection, stitch sinus, and recurrence. To overcome this complications and recurrent rates of open incisional hernia repair the Laparoscopic repair of incisional hernia was introduced in the 1990s, which reports (Olmi study) have showed more improvement in recovery time, hospital stay and complication rate. Objective: The purpose of this study was a prospective study which had been carried out, during the period of July 2010 to September 2012 at a tertiary care centre. A total number of 50 cases were studied and were followed up for a period of 6 months. All patients were operated on by the same surgical team, adapting the type of surgical technique depending on the type of hernia. In the selection process of the technique patients were ranndomly allowed to opt for any of the two modalities after analyzing the biological status of the patient but also the associated his/her comorbidities. Patient selection criteria were as below. Inclusion criteria: Wall defect: >3 cm to <8 cm, Post-surgical and gynecological procedure, BMI < 30 kg/m2, Patient willing for surgery. Exclusion criteria: Complicated hernia, BMI >30 kg/m2, Conversion of laparoscopic repair to open repair. Results: Incidence of incisional hernia was maximum in the age group of 31-50 years (66%) with female preponderance (74%). 25 patients had risk factors like chronic cough (5), hypertension (13), diabetes mellitus (5) and difficulty in micturition (2). 27 had previous emergency surgery while 23 had undergone planned surgery. 60% of patients had undergone gynecological procedures, among complications in previous surgical procedure. Mean operative time for laparoscopic incisional hernia repair was 2 hour 45 minutes and for open hernia it was 2 hour 05 minutes. 46% of patients had duration of return to work (6-10 days) in laparoscopic surgery, 40% of patients had duration of return to work (11-15 days) in open surgery (mean 16 ),4% in laparoscopic surgery (mean 10.24days), 10% of patients had duration of Return to work (16-20 days) in open surgery. Conclusion: An optimal technique for mesh placement has not yet been determined and is still a subject of debate among surgeons. Laparoscopic techniques seem to have many benefits, including decreased length of hospital stay, decreased postoperative pain, and reduce the time to return to work and normal activities, but require long learning curve and are still not very accessible to all surgeons, especially in our country.