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Ajay PS, Shah HU, Sandhu S, Sok CP, Mavani PT, Goyal S, Russell MC, Cardona K, Maegawa FB, Maithel SK, Sarmiento JM, Kooby DA, Shah MM. Significance of Specimen Extraction Site in Minimizing Hernia Risk After Distal Pancreatectomy. Ann Surg Oncol 2024:10.1245/s10434-024-16096-w. [PMID: 39192012 DOI: 10.1245/s10434-024-16096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Incisional hernia (IH) results in significant morbidity to patients and financial burden to healthcare systems. We aimed to determine the incidence of IH in distal pancreatectomy (DP) patients, stratified by specimen extraction sites. METHOD Imaging in DP patients in our institution from 2016 to 2021 were reviewed by radiologists blinded to the operative approach. Specimen extraction sites were stratified as upper midline/umbilical (UM) versus Pfannenstiel. IH was defined as fascial defect on postoperative imaging. Patients without preoperative and postoperative imaging were excluded. RESULTS Of the 219 patients who met our selection criteria, the median age was 64 years, 54% were female, and 64% were White. The majority were minimally invasive (MIS) procedures (n = 131, 60%), of which 52% (n = 64) had a UM incision for specimen extraction, including 45 hand-assist and 19 purely laparoscopic procedures. MIS with Pfannenstiel incisions for specimen extraction was 48% (n = 58), including 44 robotic and 14 purely laparoscopic procedures. Mean follow-up time was 16.3 months (standard deviation [SD] 20.8). Follow-up for MIS procedures with UM incisions was 16.6 months (SD 21.8) versus 15.5 months (SD 18.6) in the Pfannenstiel group (p = 0.30). MIS procedures with UM incisions for specimen extraction had a 17.8 times increase in odds of developing an IH compared with MIS procedures with Pfannenstiel extraction sites (p = 0.01). The overall odds of developing an IH increased by 4% for every month of follow-up (odds ratio 1.04; p < 0.001). CONCLUSION A Pfannenstiel incision should be performed for specimen extraction in cases with purely laparoscopic or robotic distal pancreatectomy, when feasible.
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Affiliation(s)
- Pranay S Ajay
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Hardik U Shah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sameer Sandhu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Caitlin P Sok
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Felipe B Maegawa
- Division of Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan M Sarmiento
- Division of Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - David A Kooby
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Pyo DH, Yun SH, Lee WY. A prospective single-arm clinical trial to assess the safety and efficacy of monofilament polydioxanone barbed suture, MONOFIX ®, on abdominal fascial closure. World J Surg 2024; 48:1674-1680. [PMID: 38877993 DOI: 10.1002/wjs.12247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND For abdominal fascial closure, the choice of optimal suture material and appropriate suture technique are of paramount importance to prevent the incidence of incisional hernia. Although barbed sutures are widely used in various surgical fields, their safety and feasibility on abdominal fascial closure which requires the most tensile strength for security have not been established yet. METHODS We conducted a prospective, single-arm, interventional clinical trial to present the postoperative outcomes of using barbed sutures in abdominal fascial closure between April 2021 and August 2021. Patients with colorectal cancer who underwent minimally invasive surgery in elective setting were included. For all participants, monofilament polydioxanone barbed suture, MONOFIX®, was used to secure the abdominal fasica. The primary outcome was the 1-year incidence of incisional hernia assessed by computed tomography. RESULTS A total of 30 patients were included. The median fascial incision length and suture length were 6.5 cm (range, 6-7.5 cm) and 31 cm (range, 27.5-39.0 cm), respectively. The median procedure time of abdominal fascial closure was 4 min (range, 3-9 min). There was no incidence of unexpected event related to suturing including suture cutting, stopper separation from threads, and suture loosening. One case of superficial surgical site infection occurred during postoperative hospital stays. There was no fascial dehiscence, incisional hernia, and adhesive ileus during a median follow-up period of 17.5 months. CONCLUSION Monofilament polydioxanone barbed suture, MONOFIX®, may be used safely and effectively on abdominal fascial closure. CLINICALTRIALS GOV NUMBER NCT05872334.
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Affiliation(s)
- Dae Hee Pyo
- Department of Surgery, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Prabha Shankar A, Mathew S, Tippana VSSN, B R K, Naik S, Pandita RK, L B, Kumar An N, Narasimha Rao V V, Kumar Bhat B, Moharana AK, Ts D. A Prospective Randomized Controlled Trial Comparing Clinical Equivalence of PD Synth and PDS Polydioxanone Sutures. Cureus 2023; 15:e50293. [PMID: 38205458 PMCID: PMC10776896 DOI: 10.7759/cureus.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Incisional hernia is a common complication of midline laparotomy that may develop even after several years of surgery. Abdominal fascia closure with ideal suture material reduces the incidence of incisional hernia. This study compared the clinical equivalence of PD Synth (Healthium Medtech Limited) and PDS (Ethicon, Johnson & Johnson) slowly absorbed polydioxanone suture with respect to the occurrence of incisional hernia, following elective/emergency midline laparotomy. Methods Eighty-eight subjects undergoing elective/emergency midline laparotomy were randomized to PD Synth (n=45) and PDS (n=43) groups of this prospective, multicenter, randomized (1:1), single-blind, two-arm, parallel-group study (December 2020-May 2023). Primary endpoint was incidence of incisional hernia, occurring within six and 12 months of surgery. Secondary endpoints included incidence of fascial dehiscence, surgical site infection (SSI), suture sinus, seroma, hematoma, scar tenderness, and re-suturing, and evaluation of operative data, hospital stay, intra-operative suture handling, pain, time to return to normal day-to-day activities and work, overall patient satisfaction score, and adverse events. Results One subject in both PD Synth and PDS groups (p>0.05) developed incisional hernia at umbilicus 12 months post-laparotomy. In PDS group, one subject each had incidences of SSI on day 2, day 7, and one month, two subjects developed seroma on day seven, and one subject had readmission on one month; two subjects in PD Synth group developed superficial SSI (one month). Findings of other secondary endpoints were comparable between the groups. Conclusion Primary and secondary outcomes manifested that PD Synth and PDS slowly absorbed polydioxanone sutures are clinically equivalent, and can be used for abdominal fascial closure following midline laparotomy.
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Affiliation(s)
- Amritha Prabha Shankar
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Stanley Mathew
- Department of General Surgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - V S S Nagababu Tippana
- Department of General Surgery, King George Hospital/Andhra Medical College, Visakhapatnam, IND
| | - Keerthi B R
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, IND
| | - Saleem Naik
- Department of General Surgery, Batra Hospital and Medical Research Center, New Delhi, IND
| | - Ravinder K Pandita
- Department of General Surgery, Batra Hospital and Medical Research Center, New Delhi, IND
| | - Badareesh L
- Department of General Surgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Naveen Kumar An
- Department of Surgical Oncology, Kasturba Medical College, Manipal, IND
| | - Venkata Narasimha Rao V
- Department of Surgical Oncology, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Bharath Kumar Bhat
- Department of Gastrosurgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Ashok K Moharana
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Iavazzo C, Gkegkes ID, Peitsidis P, Spiliotis J. Parameters affecting outcomes of transumbilical and periumbilical median incisions in ovarian cancer patients. J Turk Ger Gynecol Assoc 2023; 24:140-141. [PMID: 37284138 PMCID: PMC10258576 DOI: 10.4274/jtgga.galenos.2023.2023-1-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/17/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Ioannis D. Gkegkes
- Athens Colorectal Laboratory, Athens, Greece
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Panagiotis Peitsidis
- REA Maternity Hospital, Athens, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | - John Spiliotis
- Department of Surgical Oncology and HIPEC, European Interbalkan Medical Center, Thessaloniki, Greece
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Ozawa H, Toyota N, Sakamoto J, Nakanishi H, Nakanishi R, Fujita S. Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today 2023:10.1007/s00595-022-02636-y. [PMID: 36656391 DOI: 10.1007/s00595-022-02636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE There is still insufficient discussion of the mid- to long-term safety of the intracorporeal anastomosis (IA) method of reconstruction after laparoscopic colectomy (LAC) for colon cancer. The present study clarified the postoperative mid-term results of IA based on recurrence and the incidence of incision hernia. METHODS This single-institution observational retrospective study included 268 patients with colon cancer who underwent IA or extracorporeal anastomosis (EA) after LAC at our institution between 2018 and 2021. The mid-term results of the IA group were compared with those of the EA group using a propensity score matching method. RESULTS The median follow-up periods were 36 and 25 months in the EA and IA groups, respectively (p < 0.0001). In this matched cohort study, the recurrence-free survival (RFS) rates were comparable between the IA and EA groups (each group, n = 72; 3-year RFS: IA, 92.1%; EA, 88.2%; hazard ratio, 0.78; 95% confidence interval, 0.25-2.40; p = 0.66). The cumulative incisional hernia rates were 9.8% and 9.9% (p = 0.99) for the IA and EA groups, respectively. CONCLUSION The safety of IA after LAC was demonstrated in this study, as IA after LAC showed good mid-term results, including with regard to the rates of recurrence and incisional hernia.
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Affiliation(s)
- Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan.
| | - Naoyuki Toyota
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Junichi Sakamoto
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Hiroki Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Ryo Nakanishi
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
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