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So we will now be moving on to our oral presentations for abstract and essay competitions that we held. Joining us virtually, we have Mohammed Jawad. Um He is a general surgery resident in Pakistan and his um topic was a comparative analysis of skin only closure. Um and Bogota Bag techniques for achieving complete facial approximation and damage control abdominal surgery. Round of applause, please. Hello everyone. Um I, I am doctor, I am a secondary general surgery resident at Alba Medical Complex in Peshawar. Um I'm really grateful to incision UK and people there for providing me with this opportunity to present my work here. So, uh um my study is actually an analysis of uh two temporary abdominal closure techniques comparing um the achievement of complete part closure in a damage control abdominal surgery. Uh I'll be going through my study. My, my presentation today is our introduction, rational of my study. Uh You can see objectives, methodology results, limitations and then I'll talk about some conclusions. So uh uh temporary abdominal closure technique is usually utilized for open abdominal surgeries. Um Exposure part means that we do and the concept has become more common with the uh damage controlled surgery, which is done mainly when there is severe sepsis, um severe trauma, uh um any vascular um rupture or, or uh gut ischemia. So all these, these things can lead to uh uh ex and uh an ultimate decision for a damage controlled surgery. Um because it helps mitigate the fluid losses, infectious complications and also prevent abdominal compartment syndrome, which is a deadly complication um if it comes to that. Um So, uh the main techniques that are used uh mainly are skin only closure, uh pagoda back closure, posh closures, and vacuum sister closures. But uh in this part of the world, um the main two techniques that are used are skin only closure and the ba ba technique because of uh constraints of the resources. Uh We don't have the luxury mainly in the government hospital, gum sectors for um having a vacuum assisted closure or a patch closure technique. And, and the, the why do we use these techniques? Because they're, they're economic, they're quick and they're easily available and, and you uh so the skin only closure helps with uh fluid losses. It prevents the fluid losses, but it's become less popular because over the time due to um certain complications um such as uh abdominal compartment syndrome due to itself um also um skin has a low bursting pressure. So it can also cause evisceration of the gut sometimes. Um There are also infectious complications and loss of skin and tissue as well with the skin only closure technique. That's why it has become less popular over the time. Whereas with the be good ba technique, it's economic. Um it helps retain um prevent fluid losses or retain body fluids, retain body heat. And the best part that with you get with the pagoda back closure is through a potential organ visualization. So you can see with the naked eyes what's going on with the gut after surgery or how, how, how the patient is responding, if there's collection of an Exclu or like that. Um So uh this study today, it's sort of think of it is in a bigger context of, of uh sort of a missing piece in the puzzle, right? So the most of the studies that have been done uh that are present in the literature are mainly from the first world countries, mainly from the US, you know, and um there were literally no studies from this part of the world. Um There was this one study in done in a Dagestan, but that was also done by the US doctors in the military setting um which had a very low sample size and not very relatable circumstances to normal, you know, conditions. So this study sort of fills in the gap from uh literature that can be um that can be added from this side of the world, from the limited resource, limited side of the world, resource, limited side of the country. So, um and the main main main indication that we have from, we usually get for damage control surgery in this part of world or in this part of Pakistan mainly is um mainly the road traffic accidents, uh polytrauma cases or firearm injuries or the bone loss injuries. So we, we get these 3456 cases each day. And um that leads to decision of performing a damage control surgery or a definitive surgery uh based on the clinical judgment of the operating insertion. So this research aims to uh compare skin only closure technique and the BOGO to back closure technique in terms of the primary facial closure, which is a very important uh part when you ever deciding uh open up the patient abdomen. So the primary goal, the primary objective of this study was to compare the risk of primary facial closure. Along with that, we were also comparing the demographic and clinical variables of the patients who underwent either skin only closure or the BOGO to back closure um such as age and gender and preoperative anemia and presentation in in, in the state of shock and the blood transfusion requirement or need of vasopressors uh postoperatively. Um So, uh this was a retrospective cross section study. Uh Of course, the data was collected after getting approval from the Ethical Committee of the Ha about Medical Complex in Peshawar. And data was collected retrospectively from the medical records. Uh It was collected from January of 2019 to December 2022. And uh uh the, we compare uh the demographic and clinical variables employing Kisco tests or T tests and tests whenever the things were appropriate accordingly. Uh So a, a little about the inclusion criteria that we had was that we included all the patients who underwent temporary abdominal closure, either through skin only or the back technique. We included patients for between 15 and 75 years. So, uh since our hospital does not have the facility of periodic surgery, periodic trauma surgery, so we would only take patients age 15 or above. Um Then we, we uh took patients who had a single abdominal wall incisions, uh patient who did not undergo any abdominal wall department and had no history of prior abdominal surgeries because that was introduced by us to our uh study. So, um uh in these three years, we to in total, we had 1 93 patients um whose data was extracted and who fulfilled the inclusion criteria. And while comparing their basic demographics, we, we found that they were, you know, somewhat similar. Uh we the mean age of patients with the skin closure technique was 51.404 years. Uh Whereas what the back technique was 54.05 years. And um while talking about gender distribution, we had 27% females and 73% males who underwent damage, controlled surgery with the temporary abdominal closure technique. And if you further substrate, these, these uh groups, um gender groups based on um self skin closure and ba ba closure, we found uh almost similar distribution. Although there was no statistically significant difference found between two groups in terms of age or gender, certain other variables that we saw was the at the time of presentation, we checked if the patient had shock or anemia and what sort of uh uh temporal closure technique they underwent. So, uh uh uh it apparently the patients with shock and anemia who uh uh went underwent pagoda back closure technique more compared to skin only closure. Uh But uh the again, the difference was not statistically significant. So, um uh consequently, the number of blood transfusions, uh we see you can see on your screen that the patients with the ba closure technique underwent more transfusions. So that translates from the preoperative anemia and shocks. So they needed more transfusion fluids in and to maintain their normal uh body physiology. And uh this difference was actually statistically significant. So the need of blood transfusion was more in the the bac closure technique and skin cloth technique. But that can be, you know, uh uh caused because of the uh patients undergoing these surgeries were in shock and anemia more compared to the skin only closure technique then postoperatively uh or inoperative. The need of vasopressors and ventilator support postoperatively was seen to be higher in the Bogota back closure technique compared to the skin only closure technique. And days of the facial closure were uh um approximately the same, it was 3.34 days for the skin only closure and 3.39 days for the Bogota back technique. But uh again, the difference was not statistically significant. Uh talking about our primary outcome. Um you can see that the skin on closure patients uh had a higher facial closure rate, which was 85.1% compared to the pagoda back closure technique, which was only 65% compared to that. And we found uh sta statistically significant difference over here. And uh uh so that actually says that the skin on closure technique has a better outcome in terms of facial closure rate uh compared to the pagoda back closure technique, which also coincides with other studies that were done in the past as well. But most of the studies that were done in the past were also retrospective cross section studies. So um the, the interpretations can be limited here as well in terms of secondary outcomes, we also checked for uh compartment syndrome, uh wound, a wound infection, intra-abdominal abs formation. So uh remind you that these, these, all these these findings, these uh the outcomes that we saw were only checked during their index hospitalization. We do not have, we do not have the luxury of data from the uh you know, prospective any admissions that we had or readmissions they had or any other surgeries they underwent. So, um um looking at the stats, you can see that wound descent wound infection and intra-abdominal abscess are all more common with the pagoda back closure technique compared to the skin only closure technique except the compartment syndrome, which is more common with the skin only closure technique, which is 8.7% and roughly double the amount uh double the number of the skin only closure technique amongst all these outcomes. The only statistically significant difference was found in the wound infection rate uh which was 0.01. Uh And uh it's almost a double of uh what is found in the bego back closure compared to the skin only closure. Uh 15% of the people with the skin on closure had wound infection. Whereas the 30% of the pa patients with the balo had wound infection as a complication during the in this hospitalization. So there were certain limitations to the study. Um just as I said, it's a retrospective design. So that inherently has certain biases to itself. Uh selection bias as well we can talk about. And also uh it is important to note that decision to uh perform a damage controlled surgery. Uh And uh and the and the type of temporary abdominal closure technique was um solely based on the clinical judgment of the operating surgeon. Um So, that might have uh also introduced the selection bias. Uh in, in, in this study. And then there was also sample size limitation, we had 1 93 patients uh which makes the, the power of the study limited in terms of interpretation of the results. Um And it's a single center study. So uh the Generali is questionable here. So, um you know, uh since uh you did a different healthcare setting with the waiting um healthcare resources, so um it, it, it might be applicable to all the healthcare centers in Pakistan and in the similar countries. But um I um not in the first world countries, I presume. And uh as I said, uh we only consider data from the index hospitalizations. Uh We do not have the data or because we collected data from the medical records. And even to this day, we collect medical, we write notes, we don't have uh uh digitization of the medical records or the progress notes. So we had to scheme through the files of the patients and go to the record room, files of the patients skim through the progress notes, the operating notes and, and, and try to extract as much data as much information as I could about these patient circumstances and their outcomes. Um So, um in conclusion, we, we, we, we found that the skin closure technique was significantly, had significantly higher primary fascial closure rate compared to the bego back closure technique. And also in terms of wound infection we have, which had um lower wound infection rates compared to the Bego back closure techniques. Uh it can be, it can be blamed on uh probably uh inadequate drainage of the fluids when you apply the Bego bag. So that can lead to stasis and development of the wound infection. So that can be one reason for why there was increased chance risk of wound infection with the pagoda back closure techniques. But in general, uh the primary outcome that we had was the prime facial closure and that clearly showed that the skin closure was better in that in terms of that outcome compared to the pagoda back closure technique. Um uh in terms of future direction, uh we, we uh we suggest that future uh studies should focus on prospective Multicenter studies with the better research design such as randomized clinical trials or, or uh prospective co studies to validate the findings that we had and explore long term outcomes and also investigating the well temporary dominant closure techniques um such as uh patch closure or negative wound pressure uh dressings and see their impact on the complications quality of life. Their cost effectiveness in managing the longterm abdominal trauma is also recommended. Oh, uh Thank you so much, everybody uh for having me. I'm really grateful again to all the organizers for providing me the opportunity. This is uh a historical building in, in my city where I live. It was built in 1913 and it's currently being used as a higher education uh university sort of place. So, um yeah, I just wanted to share a bit of the background from where I come from. So, yeah, thank you so much for having me and I'll be taking any questions you might have.