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Kosugi C, Koda K, Shimizu H, Yamazaki M, Shuto K, Mori M, Usui A, Nojima H, Endo S, Yanagibashi H, Arimitsu H, Tochigi T, Sazuka T, Hirota M, Kuboki H. A Randomized Trial of Ionic Silver Dressing to Reduce Surgical Site Infection After Gastrointestinal Surgery. ANNALS OF SURGERY OPEN 2024; 5:e402. [PMID: 38883952 PMCID: PMC11175960 DOI: 10.1097/as9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/19/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To determine whether Aquacel Ag Hydrofiber dressings containing ionic silver are superior to film dressings for preventing superficial surgical site infections (SSI) in patients undergoing elective gastrointestinal surgery. Background Multiple clinical trials have assessed the effectiveness of silver-containing wound dressings; however, systematic reviews failed to find any advantages of these dressings and concluded that there was insufficient evidence to indicate that they prevented wound infections. This study aimed to evaluate the efficacy of Aquacel Ag Hydrofiber dressings for preventing superficial SSIs in patients undergoing gastrointestinal surgery. Methods Patients undergoing elective gastrointestinal surgery were randomly assigned to receive either Aquacel Ag Hydrofiber (study group) or film dressings (control group). The primary end point was superficial SSI within 30 days after surgery (UMIN Clinical Trials Registry ID: 000043081). Results A total of 865 patients (427 study group, 438 control group) were qualified for primary end-point analysis. The overall rate of superficial SSIs was significantly lower in the study group than in the control group (6.8% vs 11.4%, P = 0.019). There was no significant difference in superficial SSI rates between the groups in patients undergoing upper gastrointestinal surgery; however, the rate was significantly lower in the study group in patients undergoing lower gastrointestinal surgery (P = 0.042). Multivariate analysis identified Aquacel Ag Hydrofiber dressings as an independent factor for reducing superficial SSIs (odds ratio, 0.602; 95% confidence interval, 0.367-0.986; P = 0.044). Conclusions Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.
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Affiliation(s)
- Chihiro Kosugi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Keiji Koda
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroaki Shimizu
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Masato Yamazaki
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kiyohiko Shuto
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mikito Mori
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Akihiro Usui
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroyuki Nojima
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Satoshi Endo
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hiroo Yanagibashi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hidehito Arimitsu
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Toru Tochigi
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Tetsutaro Sazuka
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mihono Hirota
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Hideyuki Kuboki
- From the Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
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Hackl B, Zabrodska E, Gewessler S, Lilliu E, Putz EM, Kiss A, Podesser B, Todt H, Ristl R, Hilber K, Koenig X. The type of suture material affects transverse aortic constriction-induced heart failure development in mice: a repeated measures correlation analysis. Front Cardiovasc Med 2023; 10:1242763. [PMID: 37795481 PMCID: PMC10546326 DOI: 10.3389/fcvm.2023.1242763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Transverse-aortic constriction (TAC) operation is a widely used animal model to induce hypertrophy and heart failure through left-ventricular pressure overload. In mice, the cardiac response to TAC exhibits considerable variability influenced by factors such as strain, sub-strain, age, sex and vendor. Methods To investigate the impact of suture material (silk versus prolene) and size (6-0 versus 7-0) on the TAC-induced phenotype, we performed surgeries on male C57BL6/N mice at 9 weeks of age defining the aortic constriction by a 27G needle, thereby employing most frequently used methodological settings. The mice were randomly assigned into four separate groups, 6-0 silk, 7-0 silk, 6-0 prolene and 7-0 prolene (10 mice per group). Echocardiography was conducted before TAC and every 4 weeks thereafter to monitor the development of heart failure. Repeated measures correlation analysis was employed to compare disease progression among the different groups. Results Our findings reveal a significant influence of the chosen suture material on TAC outcomes. Mice operated with prolene showed increased mortality, slower body weight gain, faster left-ventricular mass increase, and a faster decline in left-ventricular ejection fraction, fractional shortening and aortic pressure gradient compared to silk-operated mice. Moreover, despite non significant, using thinner suture threads (7-0) tended to result in a more severe phenotype compared to thicker threads (6-0) across all tested parameters. Discussion Collectively, our results highlight the importance of suture material selection in determining the cardiac phenotype induced by TAC and emphasize the need to consider this factor when comparing data across different research laboratories.
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Affiliation(s)
- Benjamin Hackl
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Eva Zabrodska
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stefanie Gewessler
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Elena Lilliu
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Eva Maria Putz
- St. Anna Children’s Cancer Research Institute (CCRI), Vienna, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Todt
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Karlheinz Hilber
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Xaver Koenig
- Department of Neurophysiology and Neuropharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Zhang X, Yang Z, Yang X, Zhang F, Pan Z. Sustainable Antibacterial Surgical Suture Based on Recycled Silk Resource by an Internal Combination of Inorganic Nanomaterials. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 37318121 DOI: 10.1021/acsami.3c05054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The current antibacterial treatment methods of silk sutures can only be finished by surface modification, leading to problems of short antibacterial effects, easy slow-release consumption, prominent toxicity, and susceptibility to drug resistance. Speculatively, surgical sutures combining antibacterial material internally will possess a more promising efficacy. Hence, we extracted recycled regenerated silk fibroin (RRSF) from waste silk resources to make RRSF solutions. Internally combining with inorganic titanium dioxide (TiO2) nanoparticles, we fabricated antibacterial RRSF-based surgical sutures. The morphologies, mechanical and antibacterial properties, biocompatibility tests, and in vivo experiments were carried out. The results showed that the surgical sutures with 1.25 wt % TiO2 acquired 2.40 N knot strength (143 μm diameter) and achieved a sustainable antibacterial effect of 93.58%. Surprisingly, the sutures significantly reduced inflammatory reactions and promoted wound healing. Surgical sutures in this paper realize high-value recovery of waste silk fibers and provide a novel approach to preparing multifunctional sutures.
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Affiliation(s)
- Xin Zhang
- College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu 215021, China
| | - Zhenbei Yang
- College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu 215021, China
| | - Xin Yang
- College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu 215021, China
| | - Feng Zhang
- College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu 215021, China
- National Engineering Laboratory for Modern Silk, Suzhou 215123, China
| | - Zhijuan Pan
- College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu 215021, China
- National Engineering Laboratory for Modern Silk, Suzhou 215123, China
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Kinoshita M, Shinkawa H, Kabata D, Tanaka S, Takemura S, Amano R, Kimura K, Ohira G, Nishio K, Kubo S. Impact of Advancing Age on the Status and Risk of Postoperative Infections After Liver Resection. World J Surg 2021; 45:3386-3394. [PMID: 34244815 DOI: 10.1007/s00268-021-06236-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the recently increasing number of elderly patients undergoing liver resection, the impact of advancing age on postoperative infections (PIs) incidence and risk remains unclear. This study aimed to investigate the impact of advancing age on PIs incidence and status. METHODS This retrospective study included 744 patients undergoing liver resection without biliary reconstruction or combined resection of other organs. Multivariable analysis with a restricted cubic spline was used to evaluate the impact of advancing age on PIs and to determine its association with PIs risk in patients undergoing open and laparoscopic liver resection (OLR and LLR, respectively). RESULTS Multivariable analysis demonstrated that advancing age was significantly associated with increased PIs risk (P = 0.017). The spline curve showed that the odds ratio for PIs sharply increased starting approximately at 65 years of age. Unadjusted restricted cubic splines assessing the subcategories of PIs demonstrated that advancing age was associated with increased risks of organ/space surgical site infection and sepsis (P = 0,064 and 0.048, respectively). Multivariable analysis revealed that LLR was associated with the lower PIs risk compared with OLR (P = 0.025), whereas the lower PIs risk with LLR was not significantly obscured by advancing age (P = 0.29). CONCLUSIONS Advancing age was associated with increased risk of PIs, including organ/space surgical site infections and sepsis, after liver resection especially in patients aged ≥ 65 years.
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Affiliation(s)
- Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kohei Nishio
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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T R M, Pal S, K R AK, Bhat P, Raghupathy RK. A comparative microbiological study of polyglycolic acid and silk sutures in oral surgical procedures. Minerva Dent Oral Sci 2021; 70:239-247. [PMID: 34132506 DOI: 10.23736/s2724-6329.21.04515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Bacterial adherence to silk and polyglycolic acid suture is similar. Literature has shown bacterial adhesion is lower degree in polyglycolic acid suture compared to silk, but tissue reaction was more in the polyglycolic acid suture. The aim of the study was to compare the bacteria adhered on the silk and polyglycolic acid sutures. METHODOLOGY Sixty two patients who fulfilled the inclusion criteria were included in the study and were divided equally into group A and group B. After intraoral surgical procedures the operated site was sutured either with 3-0 black silk or 3-0 polyglycolic acid sutures in group A and B respectively. On seventh day after irrigation with normal saline sutures were removed and one suture strand was transported to the Department of Microbiology to inoculate and identify the bacteria. RESULTS - 3-0 black silk exhibited a high degree of aerobic bacteria. The bacteria identified on the suture were Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus viridians, Enterobacter, Escherichia coli, Citrobacter and Klebseilla. In 3-0 polyglycolic acid suture Pseudomonas aeruginosa, E. coli, Streptococcus Viridians bacteria were identified. DISCUSSION - PGA showed fewer bacterial adherences compared to black silk. Fewer bacterial adherence and resorbable PGA makes a better choice for intra oral surgical procedures.
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Affiliation(s)
- Marimallappa T R
- Department of Oral and MaxilloFacial Surgery, Sri Siddhartha University, Tumkur, India -
| | - Supriyo Pal
- Department of Oral and MaxilloFacial Surgery, Sri Siddhartha University, Tumkur, India
| | - Ashok K K R
- Department of Oral and MaxilloFacial Surgery, Sri Siddhartha University, Tumkur, India
| | - Preethi Bhat
- Department of Oral and MaxilloFacial Surgery, Sri Siddhartha University, Tumkur, India
| | - Ravi K Raghupathy
- Department of Oral and MaxilloFacial Surgery, Sri Siddhartha University, Tumkur, India
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Yao L, Dolo PR, Shao Y, Li C, Widjaja J, Hong J, Zhu X. Absorbable suture can be effectively and safely used to close the mesenteric defect in a gastric bypass Sprague-Dawley rat model. BMC Surg 2020; 20:8. [PMID: 31924213 PMCID: PMC6954620 DOI: 10.1186/s12893-019-0671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022] Open
Abstract
Background To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass. Methods Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson’s space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect. Results No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33 ± 0.52 respectively. The average adhesion score in group C (3.83 ± 0.41) was higher than the other groups (p<0.05). The average adhesion scores in Group D and E were similar (3.17 ± 0.41 and 3.00 ± 0.00 respectively). Conclusion Absorbable suture created a safe adhesion score between the mesentery which was not inferior to non-absorbable sutures.
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Affiliation(s)
- Libin Yao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Ponnie Robertlee Dolo
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Yong Shao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Chao Li
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Jason Widjaja
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Jian Hong
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China. .,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.
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Dou L, Liang HF, Yang HY, Ji R, Chen YF, Chen XP. Clinical Value of Trans-parenchymal Compressing Suture to Decrease the Cutting Surface Related Complications after Non-anatomical Liver Resection. Curr Med Sci 2019; 39:270-277. [PMID: 31016521 DOI: 10.1007/s11596-019-2030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Non-anatomical liver resection with appropriate resection margin is regarded as a potential curative treatment for selected major hepatic carcinoma due to preserving maximal normal liver, especially in cirrhotic patients. But occurrence of cutting surface related complications becomes a main challenge. From June 2010 to June 2016, 448 patients with major hepatic carcinoma received non-anatomical liver resection in our liver surgery center. After excluding 66 cases that were incongruent with the purpose of study, 235 patients undergoing transparenchymal compressing suture (TCS) to "not good" cutting surface were allocated as study group; 147 patients with exposed surface (ES) were matched as control group. The characteristics of postoperative drainage, postoperative hepatic and renal functions, hospital days, and outcomes were collected retrospectively. We further compared cutting surface related complications under different levels of liver cirrhosis between the two groups. Compared with ES group, patients in TCS group had a decreased incidence of cutting surface related complications (14.3% vs. 6.8%, P=0.011) and a decreased probability of interventions for cutting surface related complications (8.2% vs. 3.4%, P=0.042). TCS application was much more effective to prevent cutting surface related complications in patients with moderate and severe cirrhosis (5.4% vs. 15.8%, P=0.003). Postoperative hepatic and renal function, hospital days and mortality did not differ between the two groups. In conclusion, TCS decreases the probability of cutting surface related complications and postoperative interventions for related complications, especially in patients with moderate and severe cirrhosis.
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Affiliation(s)
- Lei Dou
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui-Fang Liang
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui-Yuan Yang
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ran Ji
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Fa Chen
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao-Ping Chen
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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8
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Chen ZS, Zhu SL, Qi LN, Li LQ. A combination of subcuticular suture and enhanced recovery after surgery reduces wound complications in patients undergoing hepatectomy for hepatocellular carcinoma. Sci Rep 2018; 8:12942. [PMID: 30154493 PMCID: PMC6113254 DOI: 10.1038/s41598-018-31287-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/09/2018] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to examine whether using subcuticular sutures during initial hepatectomy for hepatocellular carcinoma is associated with shorter postoperative length of hospital stay (PLOS) than using staples for patients treated in the enhanced recovery after surgery (ERAS) approach. A total of 376 patients were randomized to receive either subcuticular sutures or staples (188 per group), and the two groups were compared in terms of the incidence of wound complications and PLOS. Independent risk factors for PLOS were identified by multivariate analysis. Sutures were associated with significantly lower incidence of wound infection (4.3% vs. 13.3%, P = 0.020) and significantly shorter PLOS (7.97 vs. 8.45 days, P = 0.048). Independent risk factors for wound infection after hepatectomy were advanced age, increased preoperative body mass index, decreased preoperative serum albumin, and skin closure using staples. These results suggest that subcuticular sutures may be more effective than staples for conducting hepatectomy in patients with hepatocellular carcinoma who receive ERAS care.
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Affiliation(s)
- Zu-Shun Chen
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Shao-Liang Zhu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Lu-Nan Qi
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China.
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Yamamoto N, Takahashi Y, Kono T, Abe A, Kawamura K, Joujima T, Wakasugi-Sato N, Nishimura S, Oda M, Tanaka T, Kito S, Kawano K, Morimoto Y. Importance of absorbable surgical sutures for the prevention of stitch abscess after surgery in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2017; 22:e349-e353. [PMID: 28390120 PMCID: PMC5432083 DOI: 10.4317/medoral.21445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 01/01/2017] [Indexed: 01/25/2023] Open
Abstract
Background To elucidate the significance of absorbable surgical sutures in the occurrence of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC). Material and Methods The subjects were 251 patients who underwent excision and/or reconstruction and/or neck dissection for oral SCC using absorbable surgical sutures. Detection rates and characteristics of patients with stitch abscess were retrospectively evaluated by comparing between our present and previous data. Results There was only one stitch abscess among the 251 patients. A significant difference in the incidence of stitch abscess was found between the present data and our previous data. Of course, no significant correlations were found between the occurrence of stitch abscess using absorbable surgical sutures and the various factors seen in our previous analysis. Conclusions A complete switch of surgical sutures from silk to absorbable surgical sutures is needed for surgery in patients with oral SCC. Key words:Stitch abscess, oral cancer, occurrence, absorbable surgical sutures, silk suture.
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Affiliation(s)
- N Yamamoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan,
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Karavokyros I, Orfanos S, Angelou A, Meropouli A, Schizas D, Griniatsos J, Pikoulis E. Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye. Front Surg 2017; 4:17. [PMID: 28439517 PMCID: PMC5384425 DOI: 10.3389/fsurg.2017.00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Surgical site infections (SSIs) and especially organ/space infection (O/SI) after resection or ablation of liver tumors are associated with increased morbidity and mortality. A secondary blood stream infection (BSI) is considered an O/SI but the exact prevalence is unknown. We aimed to investigate the incidence of O/SI and BSIs in a cohort of consecutive patients after liver resection or ablation, to seek for a possible connection between them and to search for potential risk factors. Materials and methods We reviewed all patients who underwent hepatic resection or intraoperative liver ablation between January 2012 and December 2016 in our department. We focused on age, gender, Child–Pugh score, preoperative biliary drainage, indication for surgery, type of resection, resection or ablation of tumor, need for bilioenteric reconstruction, additional procedure to hepatectomy, blood transfusion, operative time, postoperative admission to ICU, and antibiotic chemoprophylaxis. All positive cultures from intra-abdominal fluids and blood were recorded. O/SI and BSIs were diagnosed by the criteria set by Centers for Disease Control. All variables were compared between the group with O/SI and the group without infection. BSIs were associated with these infections also. Results Eighty-one consecutive patients with a mean age of 64 years were enrolled. Fifteen patients presented a positive culture postoperatively: intra-abdominal fluid in eight, blood cultures in six, and both blood and intra-abdominal fluid in one patient. The directly estimated incidence of O/SI amounted to 11.1%. Four blood cultures were secondary to O/SI, and the remaining two secondary to central line catheter. O/SI was diagnosed indirectly, through the BSI in an additional 4.9% of the patients, raising the incidence of SSI to 16%. Among the factors studied, only admission to the ICU was found to be statistically significant as a risk factor for the development of O/SI (p = 0.026). Conclusion O/SI should be actively seeked for after liver surgery including blood cultures. Patients with affected physical status, comorbidities are in greater risk of developing O/SI.
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Affiliation(s)
- Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Orfanos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anastasios Angelou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Antonia Meropouli
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery. Surg Today 2017; 47:1208-1214. [PMID: 28303341 DOI: 10.1007/s00595-017-1503-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/07/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs); however, SSI after hepatobiliary and pancreatic surgery (HBPS) has not been well investigated in a large cohort of patients. This study analyzed the factors associated with SSI following HBPS in Japan, using a Japanese national database. METHODS Data on HBPS performed between 2012 and 2014 were extracted from a national monitoring system for HAI: The Japan Nosocomial Infections Surveillance. Using multivariate logistic regression, I assessed the factors associated with SSI. RESULTS The cumulative incidence of SSI following HBPS was 15.6% (2873/18,398). The incidence of SSI after pancreatoduodenectomy was 28.0%, which was significantly higher than that after liver resection and other types of HBPS (8.8 and 15.5%, respectively). Among the four traditional risk factors, the American Society of Anesthesiologists score was ineffective for predicting SSI in the final model of all three types of surgery. Additional risk factors were identified, including age and male gender. CONCLUSIONS The incidence of and factors associated with SSI after the three types of HBPS analyzed differed significantly. To accurately compare hospital performance in relation to SSI following HBPS, the operative procedure category in the surveillance system must be divided into three types.
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Sakoda M, Iino S, Mataki Y, Kawasaki Y, Kurahara H, Maemura K, Ueno S, Natsugoe S. Influence of a Shorter Duration of Post-Operative Antibiotic Prophylaxis on Infectious Complications in Patients Undergoing Elective Liver Resection. Surg Infect (Larchmt) 2017; 18:149-156. [DOI: 10.1089/sur.2016.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Masahiko Sakoda
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Satoshi Iino
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Yota Kawasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Shinichi Ueno
- Department of Clinical Oncology, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
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Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study. Int Surg 2016; 99:787-94. [PMID: 25437588 DOI: 10.9738/intsurg-d-13-00179.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This trial was designed to compare the efficacy of 4% chlorhexidine gluconate (CHG) with normal saline (NS) as a predisinfection skin-scrub solution prior to standard presurgical skin preparation. Data was collected at a single transplantation center where patients electing resection of hepatic tumors were recruited between October 2011 and September 2012. In total, 100 patients were consecutively enrolled for random assignment to either 4% CHG or NS as a predisinfection skin-scrub solution prior to surgery. Our aim was to assess the comparative antiseptic efficacy of CHG in this setting, focusing on cutaneous microbial colonization (at baseline, preoperatively, and postoperatively) and postsurgical site infections as primary outcome measures. Positivity rates of baseline, preoperative, and postoperative cultures were similar for both groups, showing significant declines (relative to baseline) after skin preparation and no significant postsurgical rebound. Rates of surgical site infection were also similar in both groups (CHG, 6.0%; NS, 4.1%; P = 1.0). For patients with hepatic tumors undergoing hepatectomy, the effect of 4% CHG as a predisinfection scrub solution was similar to that of NS in terms of skin decontamination and surgical site infections.
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Ito E, Yoshida M, Nakashima K, Suzuki N, Imakita T, Tsutsui N, Ohdaira H, Kitajima M, Suzuki Y. WITHDRAWN: New technique of negative pressure wound therapy for abdominal surgical site infection: Intra-wound suture and three-step closure: A case report. Ann Med Surg (Lond) 2016. [DOI: 10.1016/j.amsu.2016.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kokudo T, Uldry E, Demartines N, Halkic N. Risk factors for incisional and organ space surgical site infections after liver resection are different. World J Surg 2015; 39:1185-92. [PMID: 25561190 DOI: 10.1007/s00268-014-2922-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a common cause of major morbidity after liver resection. This study aimed to identify the risk factors for incisional and organ/space SSIs after liver resection. METHODS Our liver surgery database was retrospectively analyzed for patients treated between January 2009 and November 2012 in a tertiary care Swiss hospital. Univariate and multivariate analyses were conducted on preoperative, intraoperative, and postoperative variables to identify risk factors for incisional and organ/space SSIs. RESULTS In a total of 226 patients, SSI incidences were 12.8 % (incisional), 4.0 % (organ/space), and 1.8 % (both). Univariate analysis showed that incisional SSIs were associated with high American Society of Anesthesiologists (ASA) scores, preoperative anemia, hypoalbuminemia, low prothrombin time, viral or alcoholic chronic hepatitis, liver cirrhosis, and prolonged operation times. Organ/space SSIs were associated with high rates of red blood cell transfusions, concomitant bowel surgery, and prolonged operation times. Multivariate analysis revealed that risk factors for incisional SSIs were anemia [odds ratio (OR) 2.82], high ASA scores (OR 2.88), presence of hepatitis or cirrhosis (OR 5.07), and prolonged operation times (OR 9.61). The only risk factor for organ/space SSIs was concomitant bowel surgery (OR 5.53). Hospital stays were similar in organ/space and incisional SSI groups, but significantly longer for those with both organ/space and incisional SSIs. CONCLUSIONS High ASA scores, anemia, chronic hepatitis or liver cirrhosis, and prolonged operations increased the risk of incisional SSIs; concomitant bowel surgery increased the risk of organ/space SSI. Specific precautions to prevent organ/space and incisional SSIs may shorten hospital stays.
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Affiliation(s)
- Takashi Kokudo
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland,
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Uruno T, Masaki C, Suzuki A, Ohkuwa K, Shibuya H, Kitagawa W, Nagahama M, Sugino K, Ito K. Antimicrobial Prophylaxis for the Prevention of Surgical Site Infection After Thyroid and Parathyroid Surgery: A Prospective Randomized Trial. World J Surg 2015; 39:1282-7. [DOI: 10.1007/s00268-014-2932-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:504-11. [PMID: 23389422 DOI: 10.1007/s00534-012-0590-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into "BILI." We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance. METHODS We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery. RESULTS 1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration. CONCLUSIONS Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.
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Fujiwara Y, Yamada T, Naomoto Y, Yamatsuji T, Shirakawa Y, Tanabe S, Noma K, Kimura T, Aoki H, Matsukawa H, Kimura M, Nonaka Y, Sasaki H, Onoda T, Otawa Y, Takaoka M, Fukazawa T, Ohno Y, Fujiwara T. Multicentred surgical site infection surveillance using partitioning analysis. J Hosp Infect 2013; 85:282-8. [DOI: 10.1016/j.jhin.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
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Tsujinaka T, Yamamoto K, Fujita J, Endo S, Kawada J, Nakahira S, Shimokawa T, Kobayashi S, Yamasaki M, Akamaru Y, Miyamoto A, Mizushima T, Shimizu J, Umeshita K, Ito T, Doki Y, Mori M. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Lancet 2013; 382:1105-12. [PMID: 24075050 DOI: 10.1016/s0140-6736(13)61780-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. METHODS We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. FINDINGS 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). INTERPRETATION The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery. FUNDING Johnson & Johnson.
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Yamamoto N, Yamashita Y, Yoshiga D, Ishikawa A, Matsuo K, Miyamoto I, Oda M, Tanaka T, Kito S, Seta Y, Takahashi T, Koga H, Kawano K, Morimoto Y. Occurrence of silk stitch abscess after surgery in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2013; 18:e701-5. [PMID: 23722129 PMCID: PMC3731101 DOI: 10.4317/medoral.18792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 02/15/2013] [Indexed: 01/19/2023] Open
Abstract
Objectives: To elucidate the predisposing factors and clinical characteristics related to the occurrence of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC).
Patients and Methods: The subjects were 232 patients who underwent excision and/or reconstruction and/or neck dissection for oral SCC using silk sutures for high ligation of the blood vessels. Detection rates and characteristics of patients with stitch abscess were retrospectively evaluated by comparing patients with and without stitch abscesses after surgery diagnosed by ultrasonography and findings of various modalities in 232 patients. Several echogenic dots with subtle acoustic shadows in a hypoechoic mass were identified as the characteristic findings of stitch abscess on US. The patient groups with and without stitch abscess were compared with respect to various factors to identify those that predispose to the occurrence of stitch abscess. The factors analyzed included patients’ sex and age, chemotherapy treatment, radiotherapy treatment, the presence of a history of allergy, and blood test results.
Results: A significant correlation was found between the occurrence of stitch abscess and age, liver function abnormalities on blood tests, and the presence of a history of allergy. Multiple stitch abscesses clearly tended to occur more often than single ones in patients with stitch abscess.
Conclusions: The occurrence of stitch abscesses was related to age, liver dysfunction, and/or the presence of allergies. When diagnosing stitch abscess, the occurrence of multiple stitch abscesses is important.
Key words:Stitch abscess, oral cancer, predisposition, characteristics, squamous cell carcinoma.
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Affiliation(s)
- Noriaki Yamamoto
- Department of Dentistry and Oral-Maxillo-Facial Surgery, Oita University, Oita, Japan
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Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Fujiwara T. Risk factors for major morbidity after liver resection for hepatocellular carcinoma. Br J Surg 2012; 100:122-9. [DOI: 10.1002/bjs.8957] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Bile leakage, and organ and/or space surgical-site infection (SSI) are common causes of major morbidity after partial hepatectomy for hepatocellular carcinoma (HCC). The purpose of this study was to analyse risk factors for major morbidity and to explore strategies for its reduction after partial hepatectomy for HCC.
Methods
Risk factors for bile leakage and organ/space SSI were analysed in patients who underwent partial hepatectomy for HCC between 2001 and 2010. The causes, management and outcomes of intractable bile leakage requiring endoscopic therapy or percutaneous transhepatic biliary drainage were analysed. In addition, causative bacteria, outcomes and characteristics of organ/space SSI were investigated. Risk factors were identified using multivariable analysis.
Results
Some 359 patients were included in the analysis. The prevalence of bile leakage and organ/space SSI was 12·8 and 8·6 per cent respectively. Repeat hepatectomy and an operating time of at least 300 min were identified as independent risk factors for bile leakage. The main causes of intractable bile leakage were latent strictures of the biliary system caused by previous treatments for HCC and intraoperative injury of the hepatic duct during repeat hepatectomy. Independent risk factors for organ/space SSI were repeat hepatectomy and bile leakage. Methicillin-resistant Staphylococcus aureus was detected more frequently in organ/space SSI after repeat hepatectomy than after initial partial hepatectomy.
Conclusion
Repeat hepatectomy and prolonged surgery were identified as risk factors for bile leakage after liver resection for HCC. Bile leakage and repeat hepatectomy increased the risk of organ/space SSI.
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Affiliation(s)
- H Sadamori
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - T Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - S Shinoura
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - Y Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - R Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - D Satoh
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - D Nobuoka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - M Utsumi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - T Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
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Tsujita E, Yamashita YI, Takeishi K, Matsuyama A, Tsutsui SI, Matsuda H, Taketomi A, Shirabe K, Ishida T, Maehara Y. Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg 2012; 36:1651-6. [PMID: 22411085 DOI: 10.1007/s00268-012-1524-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated. METHODS A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups. RESULTS In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14-3 % (p = 0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15 days (p < 0.005). Multivariate analysis revealed that subcuticular absorbable suture with subcutaneous drainage significantly reduced the occurrence of incisional SSI (odds ratio; 0.15; p = 0.034). CONCLUSIONS We have demonstrated that the subcuticular suture with subcutaneous drainage is effective in preventing incisional SSI in patients undergoing Hx for HCC.
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Affiliation(s)
- Eiji Tsujita
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, 730-8619, Japan.
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Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Yoshida K, Fujiwara T. Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2012; 20:186-96. [DOI: 10.1007/s00534-011-0503-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hiroshi Sadamori
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Susumu Shinoura
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Daisuke Satoh
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Daisuke Nobuoka
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Masashi Utsumi
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
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Chung AS, Hwang HS, Das D, Zuk P, McAllister DR, Wu BM. Lamellar stack formation and degradative behaviors of hydrolytically degraded poly(ε-caprolactone) and poly(glycolide-ε-caprolactone) blended fibers. J Biomed Mater Res B Appl Biomater 2011; 100:274-84. [DOI: 10.1002/jbm.b.31950] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/05/2011] [Accepted: 07/05/2011] [Indexed: 11/12/2022]
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Harimoto N, Shirabe K, Abe T, Yukaya T, Tsujita E, Gion T, Kajiyama K, Nagaie T. Prospective randomized controlled trial investigating the type of sutures used during hepatectomy. World J Gastroenterol 2011; 17:2338-42. [PMID: 21633600 PMCID: PMC3098402 DOI: 10.3748/wjg.v17.i18.2338] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy.
METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group.
RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group.
CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.
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Yamamoto N, Yamashita Y, Tanaka T, Ishikawa A, Kito S, Wakasugi-Sato N, Matsumoto-Takeda S, Oda M, Miyamoto I, Yamauchi K, Shiiba S, Seta Y, Matsuo K, Koga H, Takahashi T, Morimoto Y. Diagnostic significance of characteristic findings on ultrasonography for the stitch abscess after surgery in patients with oral squamous cell carcinoma. Oral Oncol 2011; 47:163-9. [DOI: 10.1016/j.oraloncology.2010.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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Advantage of absorbable suture material for pulmonary artery ligation. Gen Thorac Cardiovasc Surg 2010; 58:511-5. [PMID: 20941564 DOI: 10.1007/s11748-010-0608-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The applicability of absorbable materials as ligatures of pulmonary vessels has not been described. The present study compares tissue reactions around sites of pulmonary arteries ligated with absorbable material (Vicryl) and with nonabsorbable material (silk). METHODS Beagle dogs underwent thoracotomy and the pulmonary artery branches were ligated with silk or Vicryl under general anesthesia. The ligated arterial tissues were obtained at 4 and 8 weeks after thoracotomy and processed for pathological analysis. RESULTS The arteries ligated using Vicryl or silk were clinically completely sealed at 4 weeks after ligation. More inflammation and granuloma were evident at tissues surrounding ligations made with silk than with Vicryl at 8 weeks. Hyperplasia of the arterial intima continued at 8 weeks after ligation with both Vicryl and silk sutures, although some hyperplasia similar to that in nonligated arterial intima appeared at 4 weeks after ligation. CONCLUSION Less inflammation and granuloma are caused at arterial tissues around ligations accomplished with absorbable Vicryl than those done with nonabsorbable silk sutures, although both are equally effective. Absorbable sutures might be suitable for ligating pulmonary arteries.
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Age as an independent risk factor for surgical site infections in a large gastrointestinal surgery cohort in Japan. J Hosp Infect 2010; 75:183-7. [DOI: 10.1016/j.jhin.2010.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 01/13/2010] [Indexed: 12/15/2022]
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Hu W, Huang ZM. Biocompatibility of braided poly(L-lactic acid) nanofiber wires applied as tissue sutures. POLYM INT 2010. [DOI: 10.1002/pi.2695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation? J Gastrointest Surg 2008; 12:1995-2000. [PMID: 18636300 DOI: 10.1007/s11605-008-0582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 06/16/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. METHODS Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). RESULTS The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. CONCLUSION Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.
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