Published: 2019-08-28

Comparison of interrupted-X technique closure versus conventional continuous closure of rectus sheath: a randomized control study

Balaji C., Sushanto Neogi, Sadasivam Ramasamy, Manu Vats


Background: A major surgical complication after emergency midline laparotomy is abdominal fascial dehiscence. Dehiscence is associated with increased morbidity and mortality rates up to 30%, prolonged hospital stay, and a long-term risk of developing incisional hernia. The risk factors of Wound dehiscence can surgeon factors or patient factors. This study was aimed at comparing effectiveness of interrupted-X technique versus conventional continuous closure of rectus sheath in midline laparotomy in emergency setting.

Methods: This study was conducted in a total of 100 patients underwent midline laparotomy for perforation peritonitis in emergency setting. Out of which 50 patients underwent rectus sheath closure by interrupted-X technique (group A) and 50 patients by conventional continuous closure (group B) using non-absorbable, monofilament, no.1 polypropylene suture. Necessary preoperative patient data, wound length, the time taken for rectus closure, length of the suture material used, post-operative complications like wound dehiscence, surgical site infection, period of hospital stay were recorded for analysis.

Results: Preoperative patient data among both the groups were comparable. Group A was found to have less wound dehiscence (p=0.001 for partial and p=0.008 for complete) and less period of hospital stay (p=0.054), which were statistically significant. Surgical site infections were similar in both groups. Group B was found to have less time taken for closure (p=0.003) and less length of suture material used (p=0.003), which were statistically significant.

Conclusions: Interrupted-X technique of rectus sheath closure reduces the rate of wound dehiscence and period of hospital stay, although it consumes more length of suture material and more time for suturing as compared to conventional continuous closure.


Interrupted-X technique, Conventional continuous closure, Wound dehiscence, Midline emergency laparotomy

Full Text:



Sharma S, Sunkaria BL, Singh G. A comparative study of laparotomy wounds closed with interrupted-X technique and conventional continuous closures with Vicryl. J Evol Med Dent Sci. 2017;13(6):1710-3.

Agrawal CS, Tiwari P, Mishra S, Rao A, Hadke NS. 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.

Meena K, Ali S, Chawla AS, Aggarwal L, Suhani S. A prospective study of factors influencing wound dehiscence after midline laparotomy. Surg Sci. 2013;4:354.

Broughton G, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117(7).

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

Gupta H, Srivastava A, Menon GR, Agrawal CS, Chumber S. Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials. Asian J Surg. 2008;1;31:104-14.

Dhamnaskar SS, Sawarkar PC, Vijayakumaran P, Mandal S. Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases. Internat Surg J. 2016;10;3:1751-6.

Odiya S, Hedau S, Raghuwanshi RK, Khare E. Comparative study between continuous suture and interrupted suture in laparotomy wound repair. J Evol Med Dent Sci. 2017; 6:4720-3.

Gurjar V, Halvadia BM, Bharaney RP, Ajwani V, Shah SM, Rai S, et al. Study of two techniques for midline laparotomy fascial wound closure. Ind J Surg. 2014;76:91-4.

Shashikala V, Abhilash SB, Abhishek G, Fernandes PS. A comparative study between continuous and X-interrupted sutures in emergency midline laparotomies. Internat Surg J. 2018;5:1753-7.

Jenkins TP. Incisional hernia repair: a mechanical approach. Br J Surg. 1980;67:335-6.