DOI: http://dx.doi.org/10.18203/2349-2902.isj20181437

A comparative study between continuous and x-interrupted sutures in emergency midline laparotomies

Shashikala V., Abhilash S. B., Abhishek G., Prajwal S. Fernandes

Abstract


Background: Midline laparotomy is the most common technique of abdominal incisions in both emergency and elective settings. Wound dehiscence is related to several factors pertaining to patient besides suture material and method of closure. This study tries to compare continuous sutures with x-interrupted sutures in mass closure of midline laparotomy wound in patients undergoing emergency midline laparotomy for acute peritonitis.

Methods: A total of 60 patients undergoing emergency midline laparotomy for secondary peritonitis were considered for the study, 30 of whom underwent closure of abdominal wall with continuous sutures (Group A) and the other 30 with x-interrupted sutures (Group B) using non-absorbable, monofilament, polypropylene suture. Necessary preoperative data, the time required for rectus closure, length of the suture material required, post-operative complications like surgical site infection, wound dehiscence were analyzed.

Results: The groups were comparable in means of age and sex distribution. Group A was found to have lesser time for closure of rectus, lesser suture length and lesser suture to wound length ratio when compared with Group B. Surgical site infections were similar in both groups. Patients with rectus sheath sutured in x-interrupted sutures (n=2) had significantly less wound dehiscence as compared with continuous sutures (n=8) (p<0.05).

Conclusions: Interrupted -X suture method of suturing reduces post-operative wound dehiscence, although requires more suture and consumes more time than the continuous method of suturing.


Keywords


Continuous suture, X-interrupted suture, Wound dehiscence

Full Text:

PDF

References


Ellis H. Midline abdominal incision. Br J Obstet Gynecol. 1984;91:1-2.

Riou JPA, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg 1992;163:324-330.

Townsend, Beauchamp, Evers, Mattox. Sabiston Textbook of Surgery. 20th ed. Philadelphia; Elsevier;2016:449.

Seiler CM, Bruckner T, Diener MK. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: A multicenter randomized trial. Ann Surg. 2009;249:576-82.

Krukowski ZH, Cusick EL, Engeset J. Polydioxanone or polypropylene for closure of midline abdominal incisions: A prospective comparative clinical trial. Br J Surg. 1987;74:828-30.

Corman ML, Veidenheimer MC, Coller JA. Controlled clinical trial of three suture materials for abdominal wall closure after bowel operations. Am J Surg. 1981;141:510-3.

Utpal De, Bhattacharya P, Chakraborty BP. A prospective study of cases treated by open wound management after emergency surgery for bacterial peritonitis. lnd J Surg. 2002;64(1):52-5.

Williams NS, Bulstrode CJK, O’Connell PR. Bailey and Love’s Short Practice of Surgery. 26th ed. Florida CRC Press;2013:971.

Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63:873-6.

Kendall SW, Brennan TG, Guillou PJ. Suture length to wound length ratio and The integrity of midline and paramedian incisions. Br J Surg. 1991;78:705-7.

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

Van't Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta analysis of techniques closure of midline abdominal incisions. Br J Surg. 2002;89:1350-6.

Varshney S, Manek P, Johnson CD. Six-fold suture: wound length ratio for Abdominal closure. Ann R Coil Surg Eng. 1999;81:333-6.

Sahlin S, Ahlberg J, Granström L, Ljungström KG. Monofilament versus multifilament absorbable sutures for abdominal closure. Br J Surg. 1993 Mar;80(3):322-4.

Hodgson NCF, Malthaner RA, Ostbye T. Current practice of abdominal fascial closure: a survey of Ontario general surgeons. J Canadian deChirugie. 2001;44(5):366-70.

Kumar N, Choudhary N, Sherawat RC, Hussain I, Gupta S, Om P. A prospective study to compare the suture technique (continuous versus interrupted) in prevention of burst abdomen. IOSR-JDMS. 2015;14(11):129-32.