[Suture technics for the abdominal wall after midline laparotomy].

This research article discusses a study conducted on 268 laparotomies that, due to a high incidence of post-surgery issues, prompted a look into surgical procedures and suture techniques. As a result, a modified procedure and suture technique was implemented on 14 horses and yielded no wound healing complications.

Background and Purpose

• The researchers carried out this study following the observation of a high number of complications, including seromas (pockets of serum, the liquid part of the blood), suturing material induced fistulas (abnormal connections between organs or vessels) and wound ruptures, in 268 laparotomies (surgery through the abdomen) performed through a midline incision over the past decade.
• The aim of the study was to analyse existing literature on such wound healing disturbances, especially those which have occurred due to suturing techniques, and identify possible improvements to the surgical procedure used.

New Procedure and Suture Technique

• The researchers established a new approach that minimised trauma when performing the laparotomies.
• They introduced a different methodology to close the abdominal wall, sutured layer by layer with various types of suturing materials.
• The innermost layer of the abdomen, the peritoneum, was closed with a continuous, or running, catgut suture of metric 5. The linea alba (midline of the abdomen’s muscles) was sutured using single sutures of a polyglycolic acid material of a similar gauge. Polyglycolic acid sutures are absorbable, reducing the risk of post-surgery complications such as fistulas.
• The subcutaneous layer (below the skin) was closed with a running suture of polyglycolic acid material metric 4. The skin is then sutured with single sutures of monofilamentous synthetic material metric 2, which is non-absorbable and reduces wound site irritation over long-term healing.

Results

• This revised method was then applied to 14 horses that were suffering from colic (a digestive issue common in horses), with this laparotomy approach performed.
• During the post-operation period, none of the horses showed any complications in wound healing.

Conclusion

• Based on the positive results seen in the small sample of horses, the researchers recommend further studies with a larger number of subjects. This will help validate their conclusions and determine if this surgical procedure and suturing technique can be applied broadly to reduce wound healing complications following laparotomies via midline incision.