Effectiveness of 3-Day Prophylactic Negative Pressure Wound Therapy on Closed Abdominal Incisions in the Prevention of Wound Complications: A Randomized Controlled Trial.

OBJECTIVE: To determine the impact of negative pressure wound therapy of closed abdominal incisions on wound complications. BACKGROUND: Surgical wound complications including surgical site infection complicating open abdominal operations are a burden on the economy. The outcomes of SSI include prolonged hospital stays, adjuvant treatment delay, and incisional hernias leading to a decrease in the quality of life. Prophylactic negative pressure wound therapy has recently been tried with promising results. METHODS: A randomized controlled trial involving 140 patients post-laparotomy with primary wound closure was divided into 2 groups (70 patients each). For the first group, NPWT dressings were applied for the first 3 days and then conventional dressings for 4 days after. For the second group, conventional dressings were applied for 7 days. Patients were followed up for SSI, seroma, wound dehiscence, and hospital stay. RESULTS: pNPWT was associated with a significantly lower rate of SSI development compared with gauze dressings (3/70 vs. 17/70) (p = 0.001). It also had a significant effect on lowering the incidence of seroma (0/70 vs. 7/70) (p = 0.007) and delayed wound healing (0/70 vs. 8/70) (p = 0.006) and on decreasing days of hospital stay (2.2 ± 0.6 vs. 3.5 ± 1.8) (p <0.00001). No significant difference was observed with regard to hematoma (0/70 vs. 1/70) (p = 0.5) or wound dehiscence (0/70 vs. 2/70) (p = 0.5). No burst abdomens or NPWT complications were recorded in our study. CONCLUSION: Three-day NPWT applied to primarily closed incisions is effective in reducing the incidence of SSI, seroma, and delayed wound healing in abdominal operations compared to conventional gauze dressings.

Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: a Randomized Controlled Study.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL). AIM OF THE STUDY: The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution. PATIENTS AND METHODS: This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively. RESULTS: This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors. CONCLUSION: Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases whom are more risky for bile reflux.