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Incisional closure in morbidly obese patients.
R D Cleveland1, R P Zitsch, H L Laws
1Department of Surgery, Carraway Methodist Medical Center, Birmingham, Alabama 35234.
The American Surgeon
|January 1, 1989
Summary
Gastric restrictive surgery patients face wound complications. Neither running nor interrupted sutures, nor different suture materials, reduced excessive hernia formation, indicating a need for improved closure methods.
Area of Science:
- Bariatric Surgery
- Surgical Complications
- Wound Healing
Background:
- Wound complications, particularly hernias, are a significant concern following gastric restrictive procedures.
- Current suture techniques and materials may not adequately address the high incidence of postoperative hernias in these patients.
Purpose of the Study:
- To evaluate the effectiveness of different suture techniques (interrupted vs. running) and materials in preventing hernia formation after gastric restrictive surgery.
- To identify optimal closure methods for reducing postoperative hernia complications in morbidly obese patients.
Main Methods:
- Two randomized prospective trials were conducted.
- Trial I compared interrupted Smead-Jones far-far-near-near sutures versus running sutures using Polyglactin-910 (Vicryl) #1.
- Trial II compared running #1 polydioxanone (PDS) versus #1 polypropylene (Prolene) sutures.
Main Results:
- Excessive hernia formation was observed in all patient groups, regardless of suture technique or material.
- The type of suture material (Polyglactin-910, polydioxanone, or polypropylene) did not significantly impact hernia rates.
- Interrupted and running suture closures demonstrated equal reliability in terms of hernia prevention.
Conclusions:
- Neither interrupted nor running suture techniques, nor the suture materials evaluated, effectively reduced excessive postoperative hernia formation.
- A novel closure method is required to minimize hernia development in morbidly obese patients undergoing gastric restrictive procedures.