Examples from the qualitative data representing the development of the overarching category theme ‘closure of other wounds formed during the procedure’
| Subtheme | Extract |
| Layers of wound closure (deep layers; Skin layers) | Extract 1: ‘How you close the abdominal wall I think is really important, because it then affects how likely the patient is to develop an incisional hernia. If the patient develops an incisional hernia that will impact, because of the mechanics of the abdominal wall on the stoma aperture and then lead to development of parastomal hernias. The two are intimately related. You have to take every possible step to ensure that you have good abdominal wall closure, and restoration of appropriate function, so we tend to use the small bite closure technique using 2–0 PDS delayed absorbable sutures. It’s been standard practice now for about two years, particularly for primary surgery’. (HCP: BRI0023, lower GI, RDE) Extract 2: ‘Typically I would use a glue to give you a seal. Then you haven’t got a dressing extending from the edges of the main wound, that might impinge on where your stoma bag would sit. Also the glue, even if there are leakages, will give you a seal over the centre of the wound’. (HCP: BRI0018, surgeon, hepatobiliary, RDE) |
| Order of wound closure | Extract 3: ‘At this point the end of the bowel that I've brought through is typically stapled off, and I will leave it stapled off when it’s drawn through the stoma. Then we would finish any further intraabdominal work, close the anterior abdominal wall, close the skin, dress the skin’. (HCP: BRI0018, surgeon, hepatobillary, RDE) Extract 4: ‘4.0 monocryl on curve and PDS sutures close midline umbilical port site. Mostly out of view with the handheld. Monocryl for port smaller lateral port sites. Wet and dry. Glue used (theory to reduce stoma infections). Two babcocks on distal edges of stapled stoma. Out of view. Lotus dissects the stapled line. Fine tooth forceps and 4.0 monocryl on curve secures stoma to skin with slight spout at 3, 12, 9 then 6 o’clock positions’. (Observation CM: BR0021, end colostomy, laparoscopic, RDE) |