DOI: http://dx.doi.org/10.18203/2349-2902.isj20190819

Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy

Rajesh Kumar Bansiwal, Tarun Mittal, Rajeev Sharma, Sanjay Gupta, Simrandeep Singh, Kumar Abhishek, Ashok Kumar Attri

Abstract


Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.

Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.

Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.

Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.


Keywords


Emergency, Laparotomy, Wound dehiscence

Full Text:

PDF

References


Smith JAR. Complications: Prevention and Management. Clinical Surgery in General 3rd edition. Edinburgh: Churchill-Livingstone. 1999: 350.

Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: A prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284:931-3.

Webster C, Neumayer L, Smout R, Horn S, Daley J, Henderson W, et al. Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res. 2003;109:130-7.

Gislason H, Viste A. Closure of burst abdomen after major gastrointestinal operations–comparison of different surgical techniques and later development of incisional hernia. Eur J Surg. 1999;165:958-61.

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

Chowdhury SK, Choudhury SD. Mass closure versus layer closure of abdominal wound: A prospective clinical study. J Ind Med Assoc. 1994;92:229-32.

Trimbos JB, Smit IB, Holm JP, Hermans J. A randomized clinical trial comparing two methods of fascia closure following midline laparotomy. Arch Surg. 1992;127:1232-4.

Shukla HS, Kumar S, Misra MC, Naithani YP. Burst abdomen and suture material: A comparison of abdominal wound closure with monofilament nylon and chromic catgut. Ind J Surg. 1981;43:487-91.

Gandhi JA, Shinde PH, Digarse RD. Evaluation of abdominal wall closure technique in emergency laparotomies at a tertiary care hospital. Int Surg J. 2016;3:1796-801.

Anielski R, Cichon S, Slowiaczek M, Pasierb S, Orlicki P. Wound dehiscence as a problem of the surgery department: Wiad Lek 1997;50:234-40.

Madsen G, Fisher L, Wara P. Burst abdomen- clinical features and factors influencing mortality. Danish Medical Bulletin 1992;39:183-5.

Richards PC, Balch CM, Aldrert JS. Abdominal wound closure: a randomized prospective study of 571 patients comparing continuous versus interrupted suture techniques. Ann Surg 1983;197:238-43.

McNeil PM, Sugerman HJ. Continuous absorbable vs interrupted nonabsorbable fascial closure. A prospective, randomized comparison. Arch Surg 1986;121:821-3.

Weiland DE, Bay BC, Del Sordi S. Choosing the best abdominal closure by meta-analysis. Am J Surg 1998;176:666-70.

Srivastava A, Roy S, Sahay KB, Seenu V, Kumar A, Chumber S, et al. Prevention of burst abdomen by a new technique: A randomised trial comparing continuous versus interrupted-X-suture. Ind J Surg. 2004;66:19-27.

Gupta H, Srivastava A, Menon GR, Agrawal CS, Chumber S, Kumar S, et al. Comparison of Interrupted Versus Continuous Closure in Abdominal Wound Repair: A Meta-analysis of 23 Trials. Asian J Surg. 2008;31:104-14.

Agrawal CS, Tiwari P, Mishra S, Rao A, Hadke NS, Adhikari S, et al. Interrupted Abdominal Closure Prevents Burst: Randomized Controlled Trial Comparing Interrupted-X and Conventional Continuous Closures in Surgical and Gynecological Patients. Ind J Surg. 2014;76:270–6.

Makela JT, Kiviniemi H, Juvonen T, Laitinem S. Factors Influencing wound dehiscence after midline Laparotomy. Am J Surg. 1995;170:387–90.

Sahlin S, Ahlberg J, Grantstrom L, Ljungstrom KG. Monofilament versus multifilament absorbable sutures for abdominal closure. Br J Surg. 1993;80:322-4.

Graham DJ, Stevenson JT, McHenry CR. The association of intraabdominal infection and abdominal wound dehiscence. Am J Surg. 1998;64:660-5.