Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

Authors

  • Santoshkumar N. Deshmukh Department of General Surgery, Dr. Vaishampayan Memorial Govt. Medical College, Solapur, Maharashtra, India
  • Audumbar N. Maske Department of General Surgery, Dr. Vaishampayan Memorial Govt. Medical College, Solapur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180357

Keywords:

Layered closure, Mass closure, Midline laparotomy incision

Abstract

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon. The best abdominal closure technique should be fast, easy, and cost effective while preventing both early and late complications. Present study is undertaken to compare the two methods (Mass closure and Layered closure) of laparotomy wound closure in relation to post-operative complications, time for wound closure and cost effectiveness in both groups and also to decide the most effective method among the two.

Methods: This prospective comparative study was conducted in department of surgery at a tertiary care teaching hospital at Solapur (Maharashtra) from January 2006 to January 2009. On admission, patients suspected of having intraabdominal pathology, a thorough clinical e and general assessment was done. Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy. The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection late complications.

Results: Total 60 patients of were studied. Majority of patients were in 61 to 65 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure. Mean wound closure time is more in layered closure group. Mass closure technique is more cost effective than layered closure group.

Conclusions: Mass closure technique is less time consuming, more cost effective and safe for closure of midline laparotomy incisions.

References

Ceydeli A, Wise L. Finding the best abdominal closure: an evidence based review of literature. Curr Surg. 2005;62:220-5.

Ellis H, Heddle R. Closure of abdominal wound. J R Soc Med. 1979;72:17-8.

Hodgson NC, Malthaner RA, Ostybe T. The search for an ideal method of abdominal fascial closure: a meta- analysis. Ann Surg. 2000;231:436-42.

Wissing J, Van Vroonhoven TJ, Schattenkerk ME. Fascia Closure after midline laparotomy: results of a randomised trial. Br J Surg. 1987;74:738-41.

Kendall WH, Brennan G, Guillou J. Suture length ratio and the integrity of midline and lateral paramedian incisions. Br J Surg. 1991;78:705-7.

Israelsson LA, Jonsson T. Closure of the midline laparotomy incisions with polydioxanone and nylon: the importance of suture technique. Br J Surg. 1994;81:1606-8.

Leaper DJ, Pollock AV, Evans M. Abdominal wound closure: a trial of nylon, polyglycolic acid and steel sutures. Br J Surg. 1977;64:603-6.

Khan NA, Almas D, Shehzad K. Comparison between delayed absorbable polydioxanone and non-absorbable (prolene) suture material in abdominal wound closure. PAFMJ 2009; 59(1)

Israelsson LA, Jonsson T. Closure of the midline laparotomy incisions with polydioxanone and nylon: the importance of suture technique. Br J Surg. 1994;81:1606-8.

Bloemen A, Dooren P, Huizinga BF, Hoofwijk AGM. Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure. Br J Surg. 2011;98:633-9.

Murtaza B, Khan NA, Sharif MA. Modofied abdominal wound closure technique in complicated /high risk laparotomies. J coll physicians Surg Pak. 2010;20:37-41.

Brolin RE. Prospective randomised evaluation of midline fascial closure in gastric bariatric operations. Am Surg. 1996;172:328-31.

Krukowski ZH, Matheson NA. ‘Button hole’ incisional hernia: a late complication of abdominal wound closure with continuous non-absorbable sutures. Br J Surg. 1987;74:824-5.

Ausobsky JR, Evans M, Pollock AV. Does mass closure of midline larparotomies stand the test of time? A random control clinical trial. Ann R Coll Surg Engl. 1985;67:159-61.

Pollock AV, Greenal MJ, Evan M. Single layer mass closure of major laparotomies by continuous suturing: J R Soc Med. 1917;72:889-93.

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Published

2018-01-25

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Original Research Articles