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복막염 환자에서 단속 전층 복원을 이용한 창상 관련 합병증의 예방
현상윤(Sang Yun Hyun),김용진(Yong Jin Kim),조성우(Sung Woo Cho),허경열(Kyung Yul Hur),김재준(Jae Joon Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.4
Purpose: We report here on our experience with interrupted whole layer closure of abdominal wounds with using 1-0 polyester (Green Polyester<SUP>ⓡ</SUP>, Ailee, Busan, Korea) during emergency operations for peritonitis patients. Methods: We studied 163 patients who had emergency laparotomy performed at Soonchunhyang University Hospital, the Department of Surgery from March, 2005 to February, 2008. The abdominal wall was closed by layered suture in 126 patients (the LL group), and by interrupted whole layer suture in 37 patients (the WL group). Based on the medical records, we retrospectively analyzed and compared the clinical factors and wound-related complication between the two groups. Results: Although there were no differences in age, gender, the course of admission and the chief complaint between the two groups, the WL group had a significantly greater number of patients with a deteriorated mental state, a history of shock and abnormality that was seen on chest X-ray. The average operation time was 116 minutes for the WL group and 158 minutes for the LL group, and the most common cause of peritonitis was bowel perforation in both groups (WL group: 43%, LL group: 60%) and this was followed by bowel obstruction (WL group: 19%, LL group: 18%). There were no differences in the total incidence of complications and the mortality between the two groups, but the incidence of wound-related complication was higher in the LL group (WL group: 5%, LL group: 31%). The average follow-up period was 308 days in the WL group and 222 days in the LL group. There were 2 cases of delayed wound hernia in the WL group and 6 cases in the LL group. Conclusion: Interrupted whole layer closure during performance of emergency laparotomy for peritonitis patient is very effective for preventing postoperative wound-related complication and it is as effective as layered suture for preventing delayed ventral hernia in the long-term.
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