IMPROVED ZIPPER CLOSURE OF THE ABDOMINAL-WALL IN PATIENTS REQUIRING MULTIPLE INTRAABDOMINAL OPERATIONS

Optimal management of pancreatic abscess and septic complications of a cute pancreatitis remains controversial. With the ''open packing'' app roach, repeated closure of the midline fascia is complicated by loss o f tissue integrity and suture strength. An improved zipper closure of the abdominal wall in six patients with pancreatic abscess is presente d. Improvements included: (1) using a separating jacket-type zipper to allow maximal intraoperative exposure; (2) employing a removable tuck for expansion of the patch covering the wound; (3) substituting a non meshed polytetrafluoroethylene material for the polypropylene mesh to prevent adherence to the underlying viscera; and (4) creating a flap u nderneath the zipper teeth to protect the underlying tissue from injur y. Satisfactory results were achieved with the improved zipper techniq ue.