DOI: http://dx.doi.org/10.18203/2349-2902.isj20210914

Evaluation of abdominal wound closure using continuous versus interrupted sutures in patients of perforation peritonitis

Arnab Mohanty, Yoel Dewa Paljor, Rajeev Sharma

Abstract


Background: The type of wound closure plays a critical role in patients of perforation peritonitis, since many of these patients also have poorly controlled co-morbidities and risk factors for wound dehiscence. Though many studies have evaluated abdominal wound closures in the elective scenario, similar studies in the emergent scenario are rather scarce. Hence, we have dealt with this issue in patients presenting with hollow viscus perforation peritonitis.

Methods: This was a prospective randomized case control single-centre study with 120 patients performed at St. Stephen’s Hospital, New Delhi, India between February 2016 and January 2019. These patients were randomized divided into two groups; group A comprising those patients in whom, the abdominal wound was closed with continuous sutures, and group B comprising those in whom it was closed with interrupted sutures. Informed consent was taken from all the patients. A detailed proforma included all parameters. Follow up was conducted at 2, 4, 6 and 12 weeks from the date of surgery. Data analysis was done using S.P.S.S. version 17.

Results: The time taken for continuous suture fascial closure was significantly less than the interrupted technique. There were no significant differences in other parameters, immediately or on follow-up.

Conclusions: The continuous method of abdominal closure was faster than interrupted suturing on account of the use of only two terminal knots, this difference being statistically significant. The outcomes were comparable to other studies that have dealt with this issue in elective surgeries.


Keywords


Abdominal wound closure, Continuous suture technique, Interrupted Suture technique, Laparotomy

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References


Ellis H. midline abdominal incision. Br J Obstet Gynaecol. 1984;91:1-2.

Riou JPA, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg. 1992;163:324-30.

Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence based review of the literature. Curr Surg. 2005;62(2):220-5.

Van’tRiet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques of closure of midline abdominal incisions. Br J Surg. 2002;89:1350-6.

Seiler CM, Bruckner T, Diener MK, Papyan A, Golcher H, Seidlmayer C, et al. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg. 2009;249(4):576-82.

Fast J, Nelson CA, Dennis C. Rate of gain in strength in sutured abdominal wall wounds. Surg Gyaecol Obstet. 1947;84:685-8.

Nelson CA, Dennis C. Wound healing: technical factors in the gain of strength in sutured abdominal wounds in rabbits. Surg Gynaecol Obstet. 1951;93:461-7.

Douglas DM. The healing of aponeurotic incisions. Br J Surg. 1952;40:79-84.

Lichenstein IL, Herzikoff S, Shore JM, Jiron MW, Stuart S, Mizuno L. The dynamics of wound healing. Surg Gynaecol Obstet. 1970;130:685-90.

Adamsons RJ, Enquist IE. The relative importance of sutures to the strength of healing wounds under normal and scorbutic conditions. Surg Gynaecol Obstet. 1963;117:396.

Kon MD, Meredith JW, Poole GV Jr, Martin MB, Kawamoto E, Myers RT. Abdominal wound closure: a comparison of polydioxanone, polypropylene, and Teflon coated braided Dacron sutures. Am Surg. 1984;50:549-51.

Bellon JM, Rodriguez M, Serrano N, Garcia Honduvilla N, Gomez V, Bujan J. Polypropylene and polydioxanone show similar biochemical efficacy in midline closure. Cir Esp. 2005;78(6):377-81.

Smith M, Enquist IF. A quantitative study of impaired wound healing resulting from infection. Surg Gynaecol Obstet. 1967;125:965-73.

Sanders RJ, DiClemeni D, Ireland K. Principles of abdominal wound closure: I. Animal studies. Arch Surg. 1977;112:1184-7.

Leaper DJ, Pollock AV, Evans M. Abdominal wound closure: a trial of nylon, polyglycolic acid and steel sutures. Br J Surg. 1977;64:603-6.

Tera H, Alberg C. Strength of knots in surgery in relation to type of knot, type of suture material, and dimension of suture thread. Acta Chir Scand. 1977;143(2):75-83.

Whipple AO, Ellio RHE Jr. The repair of abdominal incisions. Ann Surg. 1938;108:741-56.

Haxton H. The influence of suture materials and methods on the healing of abdominal wounds. Br J Surg. 1965;372-5.

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

Poole GV Jr, Meredith JW, Kon ND, Martin MB, Kawamoto EH, Myers RT. Suture technique and wound bursting strength. Am Surg. 1984;50:569-72.

Beanes SR, Dang C, Soo C, Ting K. The phases of cutaneous wound healing. Expert Rev Mol Med. 2003;5:1-22.

Everett WG. Suture materials in general surgery. Progr Surg. 1970;8:14-37.

Rodeheaver GT, Nesbit WS, Edlich RF, Novafil A. Dynamic suture for wound closure. Ann Surg. 1986;204:193-9.

Wissing J, van Vroonhoven TJMV, Schattenkerk ME, Veen HF, Ponsen RJG, Jeekel J. Fascia closure after midline laparotomy: results of a randomized trial. Br J Surg. 1987;74:738.

Richards PC, Balch CM, Aldrete JS. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous versus interrupted suture techniques. Ann Surg. 1983;197:238- 243.

Shoetz DJ, Coller JA, Veidenheimer MC. Closure of abdominal wounds with polydioxanone. Arch. Surg. 1988;123:72-4.

Gislason H, Gronbech JE, Soreide O. Burst abdomen and incisional hernia after major gastrointestinal operations- comparison of three closure techniques. Eur J Surg. 1995;161:349-54.

Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure. Ann Surg. 2000;231:436-42.

Trimbos JB, van Rooij J. Amount of suture material needed for continuous or interrupted wound closure: An experimental study. Eur J Surg. 1993;159:141-3.

Fagniez P, Hay JM, Lacaine F, Thomsen C. Abdominal midline incision closure. Arch Surg. 1985;120:1351-3.

Srivastava A, Roy S, Sahay KB, Seenu V, Kumar A, Chumber S, Bal S, Mehta S. Prevention of burst abdominal wound by a new technique: A randomized trial comparing continuous versus interrupted ‘x’ suture. Indian J Surg. 2004;66:220-5.

Laroche M, Harding G. Primary and secondary peritonitis: an update. Eur J Clin Microb Infect Dis. 1998;17:542-50.

Stone HH, Hoefling SJ, Strom PR, Dunlop WE, Fabian TC. Abdominal incisions: transverse vs vertical placement and continuous vs interrupted closure. South Med J. 1983;76:1106-8.

McNeil PM, Sugarman HJ. Continuous absorbable vs interrupted non-absorbable fascial closure; Arch Surg. 1986;121:821-3.

Iwase K, Higaki J, Tanaka Y, Kondoh H, Yoshikawa M, Kamike W. Running closure of clean and contaminated abdominal wounds using a synthetic monofilament absorbable looped suture. Surg Today. 1999;29(9):874-9.

Jones TE, Newell ET, Brubaker RE. The use of alloy steel wire in the closure of abdominal wounds. Surg Gynaecol Obstet. 1941;72:1056-9.

Burleson TE. Factors affecting wound healing. In: Wound healing for surgeons. London: Bailliere Tindall; 1984:42-45.

Choudhary SK, Choudhary SD. Mass closure vs layered closure of abdominal wound. A prospective clinical study. J Indian Med Assoc. 1994;92(7):229-32.

Weiland DI, Curtis Bay R, Del Sonli S. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176:666-70.

Cruse PJE, Foord R. the epidemiology of wound infection. A ten year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27-40.