Comparison Between Conventional and Modified Smead Jones Method for Mass Closure in Emergency Midline Laparotomy
NCT ID: NCT05199974
Last Updated: 2022-06-07
Study Results
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Basic Information
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COMPLETED
NA
50 participants
INTERVENTIONAL
2021-11-01
2022-05-30
Brief Summary
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Many risk factors were incriminated in causation of burst abdomen including malnutrition, anemia, hypo-proteinemia, pre and post-operative prolonged steroid therapy, peritonitis, malignancy, jaundice, uremia and post-operative abdominal distension or cough.
Wound dehiscence may be related to the technique of closure of abdomen and the sutures used. Numerous studies have been conducted evaluating many closure techniques and suture materials.
There is a number of studies evaluating various closure techniques and suture materials to prevent wound dehiscence following emergency midline laparotomy. In developing countries such as India, most patients operated as an emergency develop wound dehiscence such as they have prolonged intraperitoneal sepsis and malnutrition.
The current opinion for closure of a midline incision is mass closure with non-absorbable or slowly absorbable suture . Tension is distributed evenly along the length of the wound.
The standard technique for abdominal closure is 'mass closure' (closing all layers of the abdominal wall, excluding the skin), usually with nonabsorbable sutures, although 'slow-resorbing' sutures such as polydioxanone (PDS) are also widely used .
In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Group A: Linea alba was closed with conventional continuous technique .
Group A: 25 patients included . Linea alba will be closed with conventional continuous technique .
Midline abdominal closure
Abdominal Closure in Emergency Midline Laparotomy
Group B: Linea alba was closed with Modified Smead Jones technique with Far-near near-far technique.
Group B:25 patients included. Linea alba will be closed with Modified Smead jones technique with Far-near near-far technique.
Midline abdominal closure
Abdominal Closure in Emergency Midline Laparotomy
Interventions
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Midline abdominal closure
Abdominal Closure in Emergency Midline Laparotomy
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
* patients who underwent laparotomy through incisions other than midline incisions.
ALL
No
Sponsors
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Sohag University
OTHER
Responsible Party
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Adham Kadry Metawee
resident doctor at general surgery department sohag university hospital
Locations
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Sohag University Hospital
Sohag, , Egypt
Countries
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References
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Sajid MS, Parampalli U, Baig MK, McFall MR. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg. 2011;9(8):615-25. doi: 10.1016/j.ijsu.2011.09.006. Epub 2011 Oct 30.
Begum B, Zaman R, Ahmed M, Ali S. Burst abdomen-A preventable morbidity. Mymensingh Med J. 2008 Jan;17(1):63-6.
Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg. 2001 May;67(5):421-6.
Other Identifiers
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soh-med-21-12-08
Identifier Type: -
Identifier Source: org_study_id
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