Eventrations after median laparotomies

The proposed method of eventration treatment was used in 7 patients with a positive effect. The main element of this method is guiding Kirschner's wires through sheath of the rectus abdominis. The method may be used for prophylaxis of eventration if indicated. It has some advantages over other methods and can be recommended for use in surgical practice.     

110 consecutive laparotomies for hepatic metastasis

From 1978 to 1988, we performed 110 laparotomies for hepatic metastases. With 41 resections for colorectal metastases, the survival was 34% at 3 years. The operative mortality was 7%. With 25 resections for non colorectal liver metastases, the survival was 42% at 1 year, 12% at 3 years. The results, compared with those of literature justify, in the absence of any other potential curative treatment, to remove colorectal liver metastases. For metastases from other tumours, results of resection for endocrine tumours and few sarcomas invite us to an aggressive approach.     

Gastric Adenocarcinoma: Reduction of Perioperative Mortality by Avoidance of Nontherapeutic Laparotomy

National trends indicate a longstanding decline in gastric adenocarcinoma due presumably to a decreasing prevalence of Helicobacter pylori infection. Nonetheless, surgical outcomes continue to include relatively high morbidity and mortality rates owing to the advanced stage of disease encountered. We hypothesize that recent immigration patterns are responsible for a leveling off or even reversal of the declining incidence of gastric cancer associated with H. pylori infection. Furthermore, advances in preoperative tumor staging and nonoperative palliation currently permit better patient selection for operation with lower perioperative morbidity and mortality. A retrospective review of a consecutive case series at a public teaching hospital located in an area of high immigration was conducted that included all patients presenting, from 1995 through 2004, with gastric adenocarcinoma. For time comparison purposes, patients were divided into early (1995–1999) and recent (2000–2004) periods. There was no decline in the frequency of gastric adenocarcinoma among the study population over the 10 years. A total of 260 patients were treated of whom 137 (53%) underwent operation. The operation rate decreased and the gastric resection rate increased from the early period to the recent period as fewer incurable advanced stage (M1) patients underwent exploratory laparotomy and were palliated by nonoperative means. Perioperative morbidity and mortality rates also declined over time. Of the four total perioperative deaths, two followed 11 nontherapeutic laparotomies (18% mortality), whereas the only two additional deaths followed 122 curative or palliative laparotomies (2% mortality) (p = 0.034). We conclude that in an area of high immigration there has been no decline in gastric adenocarcinoma rates over the past decade, and the marked reduction in perioperative mortality was due to near elimination of nontherapeutic laparotomy.     

The healing of laparotomies: review of the literature

Summary Closure of laparotomy incisions continues to be followed by complications such as infection, granuloma and fistula formation, and most particularly burst abdomen and incisional hernia. In spite of technological progress in the matter of suture materials, the incidence of burst abdomen remains unchanged. This study has the object of examining in the first place the physiological and pathological processes of scar tissue formation, in order to establish what are the best means of opening and closing the abdomen, as well as giving some guidelines as to the best suture materials. Normal healing is a complex process which comprises three phases which are fundamentally the same for all tissues. However, the speed with which they develop depends on the regenerative potential and repair of the damaged tissue. Healing of a wound may be considered to be complete when it has succeeded in re-establishing the function of the tissue which was injured. Aponeuroses, the function of which is mechanical, have weak powers of regeneration, and take a long time to repair. The abdominal wall only regains its preoperative resistance and strength at the fourth post operative month. Several general and local factors may interfere with the normal healing process of a laparotomy.     

Layered and mass sutures in the closure of median laparotomies

A retrospective comparison of 2830 patients with midline abdominal incision closures was made. Dehiscences, infections, hernias were compared examining continuous mass closures (group A) versus interrupted mass closures (group B) and interrupted layered sutures (group C). The three groups were well matched for known risk factors for each of the above complications. Mass closures produced a significant higher number of infections (p = 0.0006) and hernias (p = 0.0001). There was no significant difference in the rate of dehiscences in the three suture groups (p = 0.07). A significant correlation was found in all three groups between the incidence of infections and that of outcoming incisional hernias. In the current study layered closure of the of the midline abdominal wounds yielded better results when compared with both running mass and interrupted mass closures. The knowledge of these findings might help when choosing the procedure to close a midline abdominal incision.     

Negative laparotomies in gunshot and stab injuries of the abdomen

A selective approach is taken, as a matter of principle, to cases of abdominal injuries at the Traumatological Department of the Faculty of Medicine at Instanbul University. Surgical treatment was applied to 378 in 2,968 hospitalised patients for contused or penetrating abdominal injuries, in 1983 and 1984. The rate of negative laparotomy was as low as 7.3 per cent owing to routine peritoneal flushing. However, laparotomy has been preferred and resulted in a negative laparotomy rate of 21 per cent, since problems are quite often faced in the diagnosis of stab injuries.