Resultados del cierre de pared abdominal utilizando técnica longitud sutura/herida 4:1 / Results of abdominal wall closure using the 4:1 suture/wound lenght technique
Palabras clave:
Hernia, Técnica de Sutura, Pared Abdominal / Hernia, Suture Techniques, Abdominal WallResumen
Resumen
Introducción: la laparotomía es un procedimiento cotidiano del cirujano general y una su principales complicaciones es la formación de hernias.
Objetivo: determinar si la relación 4:1 longitud de sutura-largo de herida para cierre de pared disminuye la incidencia de hernia.
Material y métodos: datos de pacientes (n = 86) en quienes se realizó cierre de pared abdominal de agosto de 2017 a enero de 2018 fueron revisados prospectivamente. Fueron excluidos los pacientes a quienes no se les pudo realizar el seguimiento adecuado, los manejados con abdomen abierto, o en los que se utilizaron materiales de sutura no absorbibles. Se formaron 2 grupos: en uno se utilizó la técnica 4:1 longitud de sutura-largo de herida como cierre de pared, y en el otro la sutura convencional; se midió la longitud de herida-largo de sutura y el seguimiento fue en el postquirúrgico. Para el análisis estadístico, se usó estadística descriptiva y estadística inferencial (chi cuadrada y U de Mann-Withney).
Resultados: los 2 grupos tuvieron características semejantes en todos los criterios de inclusión. Hubo diferencia estadísticamente significativa en dehiscencia y hernias; para ambas complicaciones, la sutura 4:1 es un factor protector. Para la primera se obtuvo una p = 0.000, razón de riesgo (RR) 0.114 con intervalo de confianza del 95% (IC 95%) 0.030-0.437 y en la segunda una p = 0.000, RR 0.091, IC 95% 0.027-0.437.
Conclusiones: el cierre de pared abdominal con longitud sutura/herida 4:1 demostró que disminuye la incidencia de hernia.
Abstract
Background: Laparotomy is a daily procedure for the general surgeon and its main complication is the formation of hernias.
Objective: To determine if the suture length to wound length ratio 4:1 for wall closure decreases the incidence of hernia.
Material and methods: Data from patients (n = 86) in whom abdominal wall closure was performed from August 2017 to January 2018 were prospectively reviewed. Patients who could not undergo adequate follow-up, those managed with open abdomen, or those with use of non-absorbable suture materials were excluded. 2 groups were formed: in one, the suture length to wound length ratio 4:1 technique was used as wall closure, and in the other it was used conventional suture; the length of the wound-suture length was measured, and the follow-up was post-surgical. For statistical analysis it was used descriptive statistics and inferential statistics (chi squared and Mann-Withney’s U).
Results: The 2 groups had similar characteristics in all the inclusion criteria. There was a statistically significant difference in dehiscence and hernias. For both complications, the 4:1 suture is a protective factor. For the first it was obtained: p = 0.000, relative risk (RR) 0.114 with 95% confidence interval (95% CI) 0.030-0.437, and for the second, p = 0.000, RR 0.091, 95% CI 0.027-0.437.
Conclusions: Abdominal wall closure using 4:1 suture/ wound length was shown to decrease the incidence of hernia.
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Referencias
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