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- Söderbäck, Harald
(författare)
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Closing the abdominal wall in high-risk abdominal surgery
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Incisional hernia and Wound dehiscence are potentially serious complications to midline incisions. Recent studies have shown that a meticulous suturing technique can reduce the rate of these complications significantly, but even with optimal technique there is 5-15% risk of abdominal wall complications. At Capio S:t Görans hospital the new abdominal wall closure technique 2012 was implemented in a standardised quality improvement project. The aim of these studies was to investigate the effect of a structured implementation of the new surgical technique, to study which risk factors for incisional hernia and wound dehiscence are relevant in a Swedish population and to test new techniques to reinforce the abdominal wall after open abdominal surgery. Methods: Study 1. All procedures performed via a midline incision 2010-2011 before, and 2016-2017 after the new protocol was introduced at Capio S:t Görans Hospital were identified and assessed for complications and risk factors for wound dehiscence and incisional hernias Study 2. All procedures registered in the Swedish Colorectal Cancer Register (SCRCR) 2007–2013 were identified. Patients with comorbid disease diagnoses, registered at admissions and visits prior to the procedure and relevant to this study, were obtained from the National Patient Register (NPR). Data on occurrence of incisional hernias were obtained by combining data from the SCRCR and the NPR). Study 3. Like study 2 all open abdominal procedures for colorectal cancer registered in the SCRCR 2007–2013 were identified. Potential risk factors for wound dehiscence were identified by cross-matching between the SCRCR and the NPR. The endpoint in this study was reoperation for wound dehiscence registered in either the SCRCR or NPR. Study 4 Sixteen patients with three or more risk factors for wound dehiscence or incisional hernia were included. A TIGR® Matrix mesh was placed on the aponeurosis with an overlap of five cm on either side and fixated with continuous monofilament polydioxanone suture. All postoperative complications were registered at clinical follow-up. Results Study 1: After the implementation of new guidelines, 93% of procedures were performed using the standardised technique for abdominal wall closure. There was no significant difference in incidence of incisional hernia or wound dehiscence between the two periods. BMI>25 and postoperative wound infection were found to be independent risk factors for incisional hernia. Male sex, high age, chronic obstructive pulmonary disease, and postoperative wound infection were risk factors for wound dehiscence. Study 2: The cumulative incidence of incisional hernia in the population was 5.3%. In multivariate analysis male gender, operation time exceeding 180 min, body mass index (BMI) > 30, age < 70 years and postoperative wound complication were significant risk factors for incisional hernia. Study 3: In multivariable analysis, age > 70 years, male gender, BMI > 30, chronic obstructive pulmonary disease, generalised inflammatory disease, and duration of surgery less than 180 min were significant risk factors for wound dehiscence. The hazard ratio for postoperative death was 1.24 for patients who underwent reoperation for wound dehiscence compared with that for controls. Study 4: One patient developed a seroma that needed drainage and antibiotic treatment. One patient had a wound infection that needed antibiotic treatment. There was no complication requiring a reoperation. No wound dehiscence or incisional hernia was seen. Conclusions: High age, high BMI, long operation time, chronic obstructive pulmonary disease, systemic inflammatory disease, and male gender should be considered risk factors for postoperative adverse events after a midline incision. Postoperative wound infection is a strong predictor of incisional hernia and wound dehiscence and all measures possible should be taken to avoid wound infection. Structured implementation of a standardised surgical technique is possible and has a long-lasting effect. Implantation of TIGR® Matrix mesh is a feasible way to reinforce the abdominal wall after high-risk surgery.
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| 2. |
- Söderbäck, Harald, et al.
(författare)
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Incidence of wound dehiscence after colorectal cancer surgery : results from a national population-based register for colorectal cancer
- 2019
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 34:10, s. 1757-1762
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient-related risk factors for wound dehiscence after colorectal surgery remain obscure.Methods: All open abdominal procedures for colorectal cancer registered in the Swedish Colorectal Cancer Registry (SCRCR, 5) 2007-2013 were identified. Potential risk factors for wound dehiscence were identified by cross-matching between the SCRCR and the National Patient Register (NPR). The endpoint in this study was reoperation for wound dehiscence registered in either the SCRCR or NPR and patients not reoperated were considered controls.Results: A total of 30,050 patients were included in the study. In a multivariable regression analysis, age > 70 years, male gender, BMI > 30, history of chronic obstructive pulmonary disease, history of generalised inflammatory disease, and duration of surgery less than 180 min were independently and significantly associated with increased risk for wound dehiscence. A history of diabetes, chronic renal disease, liver cirrhosis, and distant metastases was not associated with wound dehiscence. The hazard ratio for postoperative death was 1.24 for patients who underwent reoperation for wound dehiscence compared with that for controls.Discussion: Patients reoperated for wound dehiscence face a significantly higher postoperative mortality than those without. Risk factors include male gender, age > 70 years, obesity, history of chronic obstructive pulmonary disease, and history of generalised inflammatory disease. Patients at high risk for developing wound dehiscence may, if identified preoperatively, benefit from active prevention measures implemented in routine surgical practice.
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| 3. |
- Söderbäck, Harald, et al.
(författare)
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Incisional hernia after surgery for colorectal cancer : a population-based register study.
- 2018
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 33:10, s. 1411-1417
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Our knowledge on the incidence of incisional hernia and risk factors for developing incisional hernia following surgery for colorectal cancer is far from complete.METHODS: All procedures registered in the Swedish Colorectal Cancer Register (SCRCR) 2007-2013 were identified. Patients with comorbid disease diagnoses, registered at admissions and visits prior to the procedure and relevant to this study, were obtained from the National Patient Register (NPR). These diagnoses included cardiovascular disease, connective tissue disorders, liver cirrhosis, renal failure, diabetes, chronic obstructive lung disease and chronic inflammatory conditions. Data on occurrence of incisional hernias were obtained by combining data from the SCRCR and the NPR (International Classification of Diseases code).RESULTS: During 2007-2013, 39,984 procedures were registered in the SCRCR. After excluding laparoscopic procedures, procedures repeated on the same patient, procedures with concomitant liver resection and procedures without laparotomy, 28,913 cases remained for analysis. Five years after surgery, the cumulative incidence of incisional hernia was 5.3%. In multivariate proportional hazard analysis, significantly increased risk for incisional hernia was found for the male gender (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.21-1.62), operation time exceeding 180 min (HR 1.25, CI 1.08-1.45), body mass index (BMI) > 30 (HR 1.78, CI 1.51-2.09), age < 70 years (HR 1.34, CI 1.16-1.56) and postoperative wound complication (HR 2.09, CI 1.70-2.58).DISCUSSION: Men, patients younger than 70 years and patients with BMI > 30 face a higher risk for incisional hernia. The risk is also increased in cases where the procedure takes longer than 3 h or where postoperative wound complications occur. These patients will benefit from measures aimed at preventing the development of incisional hernia.
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| 4. |
- Söderbäck, Harald, et al.
(författare)
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Prophylactic Resorbable Synthetic Mesh to Prevent Wound Dehiscence and Incisional Hernia in High High-risk Laparotomy : A Pilot Study of Using TIGR Matrix Mesh
- 2016
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Ingår i: Frontiers in Surgery. - : Frontiers Media SA. - 2296-875X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Wound dehiscence and incisional hernia are potentially serious complications following abdominal surgery, especially if performed through a midline incision. Although prophylactic reinforcement with on-lay mesh has been shown to reduce this risk, a permanent mesh carries the risk of seroma formation, infection, and persistent pain. The aim of this study was to assess the safety of a reabsorbable on-lay mesh to reinforce the midline suture in patients with high risk for wound dehiscence or incisional hernia.Method: Sixteen patients with three or more risk factors for wound dehiscence or incisional hernia were included. A TIGR® Matrix mesh, composed of a mixture of 40% copolymer fibers of polyglycolide, polylactide, and polytrimethylene carbonate and 60% copolymer fibers of polylactide and polytrimethylene carbonate, was placed on the aponeurosis with an overlap of five on either side and fixated with continuous monofilament polydioxanone suture. All postoperative complications were registered at clinical follow-up.Results: Mean follow-up was 9 months. One patient developed a seroma that needed drainage and antibiotic treatment. One patient had a wound infection that needed antibiotic treatment. There was no complication requiring a reoperation. No wound dehiscence or incisional hernia was seen.Conclusion: On-lay placement of TIGR® Matrix is safe and may provide a feasible way of reinforcing the suture line in patients with high risk for postoperative wound dehiscence or incisional hernia. Larger samples are required, however, if one is to draw any conclusion regarding the safety and effectiveness of this technique.
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