Abdominal cavity will be closed by a single layer of 2 continuous sutures beginning on the opposite ends of the wound towards the median line and involving peritoneum, transversalis fascia, posterior and anterior layer of rectus abdominis muscle fascia and, in case of incisions beyond the lateral border of rectus abdominis muscle, also the oblique abdominal muscles fascia.

Abdominal cavity will be closed with two separate layers of continuous sutures. The first layer will include peritoneum, transversalis fascia and posterior layer of the rectus abdominis muscle fascia. In case of incisions not exceeding the lateral border of rectus abdominis muscle, the second layer will involve only the anterior layer of the rectus abdominis muscle fascia. In case of incisions exceeding the lateral border of rectus abdominis muscle, the second layer will include internal oblique abdominal muscle fascia, external oblique abdominal muscle fascia and anterior layer of the rectus abdominis muscle fascia.

Incisional Hernia

Malignancy

Mass closure technique

he first layer will include peritoneum, transversalis fascia and posterior layer of the rectus abdominis muscle fascia closed with 2 continuous sutures beginning at both ends of the wound. In case of incisions exceeding the lateral border of rectus abdominis muscle, the second layer of the continuous suture will start at the lateral border of rectus abdominis muscle, process laterally to the lateral end of the wound involving internal oblique abdominal muscle fascia. Subsequently, the suture will be led out on the anterior surface of the external oblique abdominal muscle, put through by the created loop in the medial direction and processed medially to close the external oblique abdominal muscle fascia and anterior layer of the rectus abdominis muscle fascia.

Layered closure technique

Department of General, Transplant and Liver Surgery

Risk Factors for Development of Incisional Hernia in Transverse Incisions

Study on the Risk of Incisional Hernia Development Following Transverse Epigastric Incisions in Patients Operated for Malignant Tumors

Development of burst abdomen in the immediate postoperative period (until discharge from hospital) or incisional hernia over a 2-year follow-up period (combined end-point). The follow-up protocol used for the assessment of incisional hernias at discharge from hospital and two control visits at 1 and 2 years postoperatively.

Quality of life assessed in EORTC QLQ-C30 questionnaire

surgical site infections, defined and classified according to the CDC (Centers for Disease Control) recommendations

Complications of grade III or higher according to Clavien-Dindo classification

Duration of postoperative hospitalization in days

Medical University of Warsaw

National Science Centre, Poland

The technique comprising continuous suture and mass closure will be compared to the technique 2 separate layers of continuous sutures.
Patients will be randomly assigned to one of the two techniques of abdominal closure during the operative procedure and after its main part has been completed, just before the beginning of closure of the abdominal cavity. Randomization will be performed in a 1:1 ratio and in blocks of 20 patients.

Neither the patients included in the study nor the investigators assessing the presence of incisional hernia during follow-up visits will be aware of the type of surgical technique used for abdominal closure (double-blinded study). Only the professionals present in the operating room during surgical procedure, including operator, assistants, anesthesiologist, and nurses, will be aware of the type of assigned intervention.

Lifestyle coaches will provide personalized instruction on physical activity, dietary data, and behavioral strategies.

The usual care/control groups will be followed by their primary Obstetrical provider. All overweight/obese women will be offered nutrition counseling early in pregnancy by a registered dietician to support GWG within the IOM guidelines.

Obesity

Lifestyle-related Condition

Macrosomia, Fetal

We will recruit a total of 200 overweight/obese subjects (defined as pregravid BMI 25-35 kg/m2) at the time of their first pregnancy, hereafter defined as obese for the purposes of the proposal) determined by review of the electronic medical record (EMR) after delivery of their first child.

The lifestyle intervention is healthy eating (Medeterranian diet) and exercise to decrease weight by 5-7% compared to prepregnancy weight.

Lifestyle Intervention

Pennington Biomedical Research Center

Tufts Medical Center

Massachusetts General Hospital

MetroHealth Medical Center

Cleveland Clinic

Lifestyle Intervention in Preparation for Pregnancy (LIPP)

Neonatal anthropometry and air densitometry (pea pod)

body composition, insulin sensitivity and insulin response

The results of the study will be available in a de-identified manner by contacting the Principal Investigator, after the results have been published.

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

The Cleveland Clinic

One arm study in Overweight Type 2 Diabetes Mellitus

Overweight Type 2 Diabetes Mellitus

Sex: Female, Male

Region of Enrollment

Change: Weight after 12 months of therapy or more - weight at baseline

Change in Weight From Baseline at 12 Months or More

Change: Body Mass Index (BMI) after 12 months of therapy or more - BMI at baseline

Change in Body Mass Index (BMI) From Baseline at 12 Months or More

Change: Waist circumference after 12 months or more of therapy - Waist circumference at baseline

Change in Waist Circumference From Baseline at 12 Months or More

Change: Waist circumference/Hip circumference ratio after 12 months or more of therapy - Waist circumference/Hip circumference ratio at baseline

Change in Waist Circumference (Cms)/Hip Circumference (Cms)From Baseline at 12 Months or More

Change: Waist/Height ratio after 12 months or more of therapy - Waist/Height ratio at baseline

Change in Waist (Cms) /Height (Meters) Ratio From Baseline at 12 Months or More

Change: Fasting blood glucose after 12 months or more of therapy - Fasting blood glucose at baseline

Change in Fasting Blood Glucose From Baseline at 12 Months or More

Change: Glycosylated Haemoglobin after 12 months or more of therapy - Glycosylated Haemoglobin at baseline.

Change in Glycosylated Haemoglobin (A1C) From Baseline at 12 Months or More

Metformin in Maximum Tolerated Dose

Metformin for 12 Months or More

Dr. Amulya R Sircar

Type 2 Diabetes Mellitus

0.5g twice a day to 2g twice a day for at least 12 months or more

Extended Release Metformin

Sircar Diabetes Clinic

Metformin in Overweight Type 2 Diabetes Mellitus

Metformin Monotherapy Significantly Improves Anthropometric and Glycemic Values in Overweight Type 2 Diabetes Mellitus: One Year or More Prospective Study.

acetone/fatigue

Risk Factors for Development of Incisional Hernia in Transverse Incisions

Lifestyle Intervention in Preparation for Pregnancy (LIPP)

Metformin in Overweight Type 2 Diabetes Mellitus

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