A study to assess the acceptability of the alexis retractor and a brief description of post operative wound complications associated with its use
Date
2018
Authors
Mlandu, Dr Y P
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Abstract
Introduction Deliveries by caesarean section are increasing and so is the morbidity and mortality associated with this procedure. It is therefore important to consider strategies to reduce the mortality and morbidity. The Alexis-O abdominal wall retractor is a single use device that offers good visibility of the abdominal cavity. It has the added benefit of making it easy to suture the uterus without having to exteriorise it and has been associated with reduced wound sepsis in bowel surgery. The primary outcomes of this study were to assess the operators’ assessment of the ease of the operation when using the Alexis-O abdominal wall retractor and to determine difficulties experienced by the surgeon and to describe these difficulties. The secondary outcomes were; to assess the frequency with which it was not possible to place the Alexis-O abdominal wall retractor or the operator was forced to abandon its use, the duration of the operation, the estimated blood loss, the patients’ maximum perception of post-operative pain on an analogue scale, the incidence of immediate post-operative pyrexia, the length of hospital stay and the incidence of post-operative wound complications as reported by the discharging doctor and through a telephonic interview with the patient three weeks after discharge from the hospital. Methods This was a case series of caesarean sections performed at the Chris Hani Baragwanath Academic Hospital designed to be a ‘pilot study’ in which the Alexis-O abdominal wall retractor was used. The Alexis-O abdominal wall retractor is a disposable, single-use device that consists of a flexible polymer transparent membrane formed into the shape of a cylinder. Attached to each end of the cylinder are two semi rigid polymer rings.
There are two obstetrics theatres running concurrently for 24 hours where elective and emergency caesarean sections are performed. A convenience sample of a 100 women undergoing both elective and emergency caesarean sections was taken. The
surgeons completed a questionnaire after the surgery, other details were taken from hospital notes and the patients were assessed by a discharge questionnaire and again telephonically three weeks after the surgery. Results A total of 39 surgeons took part in the study. There were five consultants, 31 registrars and three medical officers. A total of 106 patients were enrolled. Ten caesarean sections were performed by consultants, 83 were performed by registrars and 13 by medical officers. In 82.2% of cases the surgeons preferred the Alexis-O abdominal wall retractor over the standard retractor which they had previously used and in 88% of cases the surgeons found the Alexis-O abdominal wall retractor easy to use. In 97.1% of cases the surgeons indicated that they would use the Alexis-O abdominal wall retractor again. There were a total of 12 cases, performed by 11 surgeons, where the surgeons found the Alexis-O abdominal wall retractor difficult to use. In 11 of these cases the surgeons had used the Alexis-O less than 20 times and in seven of these cases the surgeons indicated that they preferred the standard abdominal wall retractor above the Alexis-O abdominal wall retractor. In three cases the surgeons were unable to insert the Alexis-O abdominal wall retractor due to dense adhesions. In six cases the surgeons abandoned the Alexis-O abdominal wall retractor either due to adhesions or poor visibility of parts of the operating field. There were no complications from the removal of the Alexis-O abdominal wall retractor. Of the 106 patients who were enrolled in the study, 18 had wound complications. One patient had puerperal sepsis and a hysterectomy was performed, the other 17 patients had wound complications that did not require surgery. Of these complications, eight patients were treated with oral or intravenous antibiotics, removal of sutures, draining of pus and dressing of wounds. No control group was available for comparison. Sixteen patients were lost to follow up.
Conclusion The Alexis-O abdominal wall retractor was preferred by the majority of surgeons, the majority of whom found it easy to use. Since this is a case series, it is not possible to ascertain if this device is superior to standard abdominal wall retractors. A randomised control trial would be ideal to assess these outcomes.
Description
THIS IS A RESEARCH REPORT SUBMITTED TO THE UNIVERSITY OF THE WITWATERSRAND IN COMPLIANCE WITH THE MASTERS OF MEDICINE DEGREE