A comparative study on surgical site infections after primary closure and delayed primary closure in clean contaminated laparotomy cases

T. J. Pauly, T. V. Haridas, E. Manoj Prabhakar, Roshjo Roshan


Background: Surgical site infection is a significant cause of post operative morbidity. Timing of skin closure following a surgery and its relation to incidence of infection has been studied. The debate whether primary or delayed primary closure have been around for a long time. The aim of this study is to compare the rate of infection in a laparotomy wound in clean contaminated laparotomy cases after primary and delayed primary closure.

Methods: 132 patients who underwent laparotomy for clean contaminated were selected. Of this primary closure of the skin was done in 66 cases and delayed primary closure at 48 hours were done in the other 66 patients. Wounds were followed up till post op day 7. The results between two groups were compared using chi square test.

Results: two out of 66 cases developed SSI in the delayed primary sutured group whereas 8 out of 66 cases developed SSI in primary suturing group. The results were compared using chi square test and the chi square statistic was 3.8951 and the p value is 0.048428 (<0.05) proving the result significant.

Conclusions: The incidence of surgical site infection in laparotomy wound after a primary closure was higher compared to delayed primary closure in clean contaminated laparotomy wounds and the difference is significant based on statistical evaluation.


Clean contaminated wounds, Delayed primary closure, Surgical site infection

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Cruse PJ, Foord R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surgical Clin N Am. 1980;60(1):27-40.

Walter JB, Talbot IC. Wound healing. In: General Pathology. 7th Ed. Churchill Livingstone 1996: 165–179.

Forrester JC. Collagen morphology in normal and wound tissue. InWound healing and wound infection: theory and surgical practice. Appleton-Century-Crofts, New York. 1980: 118-133.

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 (Larchmt). 2012;13:257-65.

Olson M, O'Connor M, Schwartz ML. Surgical wound infections. A 5-year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Ann Surg. 1984;199(3):253-9.

Brown SE, Allen HH, Robins RN. The use of delayed primary wound closure in preventing wound infections. Am J Obstetr Gynecol. 1977;127(7):713-7.

Hepburn HH. Delayed primary suture of wounds. Br Med J. 1919;1(3033):181.

Smilanich RP, Bonnet I, Kirkpatrick JP. Contaminated wound: the effect of initial management on outcome. Am J Surg. 1995;61:427-30.

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 Emergency Surg. 2014;9(1):49.

Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial. Journal of the Chinese Medical Association. 2012;75(4):156-9.

Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005;23(4):249.