King Saud Medical City, Riyadh, Saudi Arabia.
Aalborg University Hospital, Aalborg, Denmark.
Colorectal Dis. 2023 May;25(5):1014-1025. doi: 10.1111/codi.16500. Epub 2023 Mar 31.
The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI).
An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices.
A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n = 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n = 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice.
Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements.
腹部伤口失败的负担可能是深远的。最近的临床指南强调了剖腹关闭技术的异质性。本研究的目的是调查当前的中线闭合技术和预防手术部位感染（SSI）的实践。
2021 年，一项在线调查在欧洲结直肠病学会及其合作伙伴协会的会员中进行。外科医生被要求提供有关他们将如何在三种特定临床情况下关闭腹壁以及预防 SSI 实践的信息。
共有 561 名顾问和实习外科医生参与了这项调查，主要来自欧洲（n=375，66.8%）。其中，60.6%的人认为自己是结直肠外科医生，39.4%的人是普通外科医生。大多数人使用聚二恶烷酮进行筋膜闭合，在清洁污染病例中主要采用小咬技术（74.5%，n=418）。顾问和实习外科医生之间没有发现显著差异。在预防 SSI 方面，更多的外科医生更喜欢单独使用机械肠道准备（MBP），而不是 MBP 和口服抗生素联合使用。大多数外科医生更喜欢使用 2%酒精氯己定（68.4%）或水性聚维酮碘（61.1%）进行皮肤准备。大多数人不使用三氯生涂层缝线（73.3%）或术前预热伤口部位（78.5%），无论培训水平或欧洲/非欧洲实践如何。
外科医生之间的腹部伤口闭合技术和 SSI 预防策略差异很大。对于伤口闭合材料或技术，几乎没有风险分层的方法，大多数外科医生对所有患者情况都使用相同的策略。实践的协调和外围技术的限制可能会为患者带来更好的结果，并为进一步潜在改进的引入和评估提供一个稳定的平台。
