Comparison of surgical site infection and wound dehiscence rates between primary and delayed primary closure of incision in ileal perforation patients

Sabrina Akhter Qurashi; Asif Aman; Satya Ranjan Mondal; Jalal Ahmed; M. Meher Ullah; A. Z. M. Mahfuzur Rahman

doi:10.18203/2349-2902.isj20251901

Authors

Sabrina Akhter Qurashi Department of Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
Asif Aman Department of Surgery, Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh
Satya Ranjan Mondal Department of Surgery, Bangladesh Medical College Hospital, Dhaka, Bangladesh
Jalal Ahmed Department of Surgery, Mugda Medical College Hospital, Dhaka, Bangladesh
M. Meher Ullah Department of Surgery, Satkhira Medical College Hospital, Satkhira, Bangladesh
A. Z. M. Mahfuzur Rahman Department of Surgery, Satkhira Medical College Hospital, Satkhira, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20251901

Keywords:

Ileal perforation, SSI, Wound dehiscence, Primary closure, Delayed primary closure

Abstract

Background: Ileal perforation is a common surgical emergency associated with significant postoperative complications, particularly surgical site infection (SSI) and wound dehiscence. The method of wound closure, primary closure (PC) versus delayed primary closure (DPC), may influence these outcomes. This study aimed to compare the rates and timing of SSI and wound dehiscence between primary and delayed primary wound closure in patients undergoing surgery for ileal perforation.

Methods: This quasi-experimental study was conducted at the Department of Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh, from September 2022 to August 2023. The study included 34 patients diagnosed with ileal perforation who underwent laparotomy at the Department of Surgery of Dhaka Medical College Hospital. All patients were equally allocated into two groups: Group A- Patients who underwent primary wound closure (PC), and Group B - Patients who underwent delayed primary wound closure (DPC).

Result: The baseline characteristics (age, gender, and BMI) were similar between the groups (p>0.05). SSI occurred in all patients in Group A (100%) compared to only 8 patients (47.1%) in Group B, showing a significant reduction in SSI with DPC (p<0.001). Most SSIs in Group A occurred on the 5th POD, while in Group B, the peak was on the 10th POD. Partial wound dehiscence was significantly more common in Group A (64.7%) compared to Group B (23.5%) (p=0.038). Although complete dehiscence was higher in Group A (35.3%) than Group B (11.8%), the difference was not statistically significant (p=0.225). Notably, 64.7% of patients in the DPC group had no wound dehiscence, while none in the PC group avoided this complication (p<0.001).

Conclusions: This study showed that delayed primary closure significantly reduces the incidence of surgical site infection and wound dehiscence in ileal perforation, making it a preferable option in ileal perforation case.

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References

Afridi SP, Malik F, Rahman S, Shamim S, Samo AK. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World J Emerg Surg. 2008;3:31. DOI: https://doi.org/10.1186/1749-7922-3-31

Wani RA, Parray FQ, Bhat NA, Wani MA, Farzana F. Nontraumatic terminal ileal perforation. World J Emerg Surg. 2006;1:1–6. DOI: https://doi.org/10.1186/1749-7922-1-7

Capoor MR, Nair D, Chintamani MS, Khanna J, Aggarwal P, Bhatnagar D. Role of enteric fever in ileal perforations: an overstated problem in tropics? Indian J Med Microbiol. 2008;26:54–7. DOI: https://doi.org/10.1016/S0255-0857(21)01993-9

Malik AM, Laghari AA, Mallah Q, Qureshi GA, Talpur AH, Effendi S, et al. Different surgical options and ileostomy in typhoid perforation. World J Med Sci. 2006;1:112–6.

Leaper DJ. Surgical infection. In: Williams NS, Bulstrode CJK, O’Conell PR, editors. Bailey and Love’s short textbook of Surgery. 25th ed. London: Hodder Arnold. 2008: 32–48.

Burt BM, Tavakkolizadeh A, Ferzoco SJ. Incisions, closures, and management of the abdominal wound. In: Zinner MJ, editor. Maingot’s Abdominal Operations. 11th ed. New York: McGraw Hill. 2007: 71–98.

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Saunders. 2008: 328–34.

Agrawal V, Sharma N, Joshi MK, Minocha VR. Role of suture material and technique of closure in wound outcome following laparotomy for peritonitis. Trop Gastroenterol. 2009;30:237–40.

Baksi A, Chatterjee S, Ray U, Nilima N, Khan WF, Banerjee N. A randomized trial analyzing the effects of primary versus delayed primary closure of incision on wound healing in patients with hollow viscus perforation. Turk J Surg. 2020;36(4):327–32. DOI: https://doi.org/10.47717/turkjsurg.2020.4882

Sasikumar MN, Mammen SC. Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis. Int Surg J. 2019;6(10):3708–14. DOI: https://doi.org/10.18203/2349-2902.isj20194429

Singh PK, Saxena N, Poddar D, Gohil RK, Patel G. Comparative study of wound healing in primary versus delayed primary closure in contaminated abdominal surgery. Hell J Surg. 2016;88:314–20. DOI: https://doi.org/10.1007/s13126-016-0340-8

Hedrick TL, Sawyer RG, Hennessy SA, Turrentine FE, Friel CM. Can we define surgical site infection in colorectal surgery. Surg Infect. 2014;15(4):372–6. DOI: https://doi.org/10.1089/sur.2013.013

Fukuda H, Morikane K, Kuroki M, Kawai S, Hayashi K, Ieiri Y, et al. Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption. Infect. 2012;40(6):649–59. DOI: https://doi.org/10.1007/s15010-012-0317-7

Kusachi S, Kashimura N, Konishi T, Shimizu J, Kusunoki M, Oka M, et al. Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance. Surg Infect. 2012;13(4):257–65. DOI: https://doi.org/10.1089/sur.2011.007

Gottrup F, Melling A, Hollander DA. An overview of surgical site infections: aetiology, incidence and risk factors. Available at: http://www.worldwidewounds.com Accessed on 21 December 2024.

Poole D, Chieregato A, Langer M, Viaggi B, Cingolani E, Malacarne P, et al. Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts. PLoS One. 2014;9(11):113676. DOI: https://doi.org/10.1371/journal.pone.0113676

Duttaroy DD, Jitendra J, Duttaroy B, Bansal U, Dhameja P, Patel G, et al. Management strategy for dirty abdominal incisions: primary or delayed primary closure. A randomized trial. Surg Infect. 2009;10(2):129–36. DOI: https://doi.org/10.1089/sur.2007.030

Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: a prospective randomized controlled trial. J Chin Med Assoc. 2012;75(4):156–9. DOI: https://doi.org/10.1016/j.jcma.2012.02.013

Aziz I, Baloch Q, Zaheer F, Iqbal M. Delayed primary wound closure versus primary wound closure–a dilemma in contaminated abdominal surgeries. J Liaquat Univ Med Health Sci. 2015;14(03):5.

Ahmad M, Ali K, Latif H, Naz S, Said K. Comparison of primary wound closure with delayed primary closure in perforated appendicitis. J Ayub Med Coll Abbottabad. 2014;26(2):153–7.

Chhaparwal P, Meena YK, Sharma BK, Mishra MC. Comparative study of primary closure versus delayed primary closure of skin in contaminated and dirty abdominal wounds/incision. Int J Sci Res. 2020;10(6):656–68. DOI: https://doi.org/10.21275/SR21609170454

Bhadragoudra J, Narasanagi B, Vallabha T, Sindagikar V. Comparative study of delayed primary closure versus primary closure of skin in contaminated and dirty abdominal wounds/incision. Int J Clin Biomed Res. 2016;2(1):16–9.

Siribumrungwong B, Noorit P, Wilasrusmee C, Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials of delayed primary wound closure in contaminated abdominal wounds. World J Emerg Surg. 2014;9(1):1–8. DOI: https://doi.org/10.1186/1749-7922-9-49

Nasib G, Shah SI, Bashir E. Laparotomy for peritonitis: primary or delayed primary closure. J Ayub Med Coll Abbottabad. 2015;27(3):543–5.

Mostafa AAS, Borai MIH, Ghanema MKH. Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis. Med J Cairo Univ. 2020;88(3):1257–64. DOI: https://doi.org/10.21608/mjcu.2020.110877

Singh V, Kalathiya D, Shah S. Primary versus delayed wound closure technique in infected laparotomy wounds. Medico-Legal Update. 2021;21(2):1–6. DOI: https://doi.org/10.37506/mlu.v21i2.2862

Ahmed A, Hanif M, Iqbal Y. A comparison of primary closure versus delayed primary closure in contaminated abdominal surgery in terms of surgical site infection. J Postgrad Med Inst. 2013;27(4):1–6.

Ashraf SM, Mehdi SH, Umer MF, Muttaqi A. Comparative study of wound healing in primary versus delayed primary closure in contaminated abdominal surgery. Pak J Surg. 2009;25(2):115–7.