An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology.
Chowdhury, Sharfuddin El-Hussuna, Alaa Gallo, Gaetano Keatley, James Kelly, Michael E Minaya-Bravo, Ana Ovington, Liza Pata, Francesco Pellino, Gianluca Pinkney, Thomas
Chowdhury, Sharfuddin
El-Hussuna, Alaa
Gallo, Gaetano
Keatley, James
Kelly, Michael E
Minaya-Bravo, Ana
Ovington, Liza
Pata, Francesco
Pellino, Gianluca
Pinkney, Thomas
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2023-03-31
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Abstract
Aim: 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).
Method: 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.
Results: 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.
Conclusion: 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.
Citation
Chowdhury S, El-Hussuna A, Gallo G, Keatley J, Kelly ME, Minaya-Bravo A, Ovington L, Pata F, Pellino G, Pinkney T, Sanchez Guillen L, Schmitz ND, Spychaj K, Riess C, van Ramshorst GH; 2021 European Society of Coloproctology (ESCP) collaborating group. An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology. Colorectal Dis. 2023 May;25(5):1014-1025. doi: 10.1111/codi.16500. Epub 2023 Mar 31.
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Article