A randomised study to evaluate wound outcome following delayed primary vs primary closure of skin in duodenal perforation peritonitis

Authors

  • Sajal Gupta Department of General Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Vimal Bhandari Department of Surgery, VMMC & Safdarjung Hospital, New Delhi, India
  • I. B. Dubey Department of Surgery, VMMC & Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20212716

Keywords:

Delayed primary closure, Duodenal perforation, Wound outcome

Abstract

Background: This study aimed to evaluate wound outcome following delayed primary versus primary closure of skin in duodenal perforation peritonitis.

Methods: The present study was a randomised interventional study that included 90 patients on accrual of duodenal perforation peritonitis which were divided into primary closure (PC) and delayed primary closure (DPC) groups comprising 45 patients each. The outcome measures were complications, surgical site infections, hospital stay and final wound status during the follow up of 30 days. Data collected was compared taking P-value <0.05 as significant.

Results: The patients were in the age group of 12–60 years, with men in majority in both groups. Mean SSI score in PC and DPC was comparable (2.67 SD 1.58 vs. 2 SD1.61, P=0.058). SSI was more in PC group than DPC group (11.11% vs. 2.22%, P<0.05). Wound/pus culture was positive in 62.22% in PC and 46.67% in DPC. Major complications like wound dehiscence was noticed mainly in PC group while minor Complications like Stitch abscess, granuloma, sinus was more in DPC group. Mean of duration of stay (days) was comparable between PC and DPC group (14.07 SD 7.64 vs. 13.96 SD 6.94, P=0.805). Final wound outcome after 30 days was healthy scar in majority of patients in PC and DPC group (57.78% vs. 66.67%) with no significant difference between them (p=0.434).

Conclusions: In conclusion, DPC showed comparable results with PC with similar SSI and wound healing without significant complications.

References

Ansari D, Toren W, Lindberg S, Pyrhönen HS, Andersson R. Diagnosis and management of duodenal perforations: a narrative review. Scandinavian J Gastroenterol. 2019;54(8):939–44.

Haruna L, Aber A, Rashid F, Barreca M. Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology. BMC Surg. 2012;12:21.

Thorson CM, Paz Ruiz PS, Roeder RA, Sleeman D, Casillas VJ. The perforated duodenal diverticulum. Arch Surg. 2012;147:81–8.

Ueda N. Gastroduodenal perforation and ulcer associated with rotavirus and norovirus infections in Japanese children: a case report and comprehensive literature review. InOpen forum infectious diseases 2016 (Vol. 3, No. 1). Oxford University Press.

Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP. 2012;13(1):18-25.

Moller MH, Adamsen S, Thomsen RW, Møller AM, Peptic Ulcer Perforation (PULP) trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98:802–10.

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102–113.

Leaper DJ. Surgical infection. In: Williams NS, Bulstrode CJK, O’Conell PR (Eds) Bailey and Love’s Short Textbook of Surgery, 25th ed. Hodder Arnold; 2008:32–48.

Burt BM, Tavakkolizadeh A, Ferzoco SJ. Incisions, closures, and management of the abdominal wound. In: Zinner MJ (Ed) Maingot’s Abdominal Operations, 11th edition. McGraw Hill Medical Publication; 2007:71–98.

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (Eds) Sabiston Textbook of Surgery, 18th ed. Saunders Publication; 2008:328–334.

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. 2012;13:257–265.

Andersson AE, Bergh I, Karlsson J, Nilsson K. Patients’ experiences of acquiring a deep surgical site infection: an interview study. Am J Infect Control. 2010;38:711–7.

Henry MCW, Moss RL. Primary versus delayed wound closure in complicated appendicitis: An international systematic review and meta-analysis. Pediatr Surg Int. 2005;21:625–30.

Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial. J Chin Med Assoc. 2012;75:156–9.

Cohn SM, Giannotti G, Ong AW, Varela E, Shatz DV, McKenney MG, et al. Prospective randomised trial of two wound management strategies for dirty abdominal wounds. Ann Surg. 2001;233:409–13.

Ussiri EV, Mkony CA, Aziz MR. Sutured and open clean contaminated and contaminated laparotomy wounds at Muhimbili National Hospital: a comparison of complications. East Cent Afr J Surg. 2004;9:89–95.

Duttaroy DD, Jitendra J, Duttaroy B, Bansal U, Dhameja P, Patel G, et al. Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial. Surg Infect (Larchmt). 2009;10:129–36.

Watanabe A, Kohnoe S, Shimabukur OR, Yamanaka T, Iso Y, Baba H, et al. Risk factors associated with surgical site infection: Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today. 2008;38:404–12.

Bahar MM, Jangjoo A, Amouzeshi A, Kavianifar K. Wound Infection Incidence in patients with simple and gangrenous or perforated appendicitis. Arch Iran Med. 2010;13:13–6.

Pinkney TD, Bartlett DC, Hawkins W, Mak T, Youssef H, Futaba K, et al. Reduction of surgical site infection using a novel intervention (ROSSINI): study protocol for a randomized controlled trial. Trials. 2011;12:217.

Murtaza B, Ali Khan N, Sharif MA, Malik IB, Mahmood A. Modified midline abdominal wound closure technique in complicated/high risk laparotomies. J Coll Physicians Surg Pak. 2010;20:37–41.

Ahmed A, Hanif M, Iqbal Y. A comparison of primary closure versus delayed primary closure in contaminated abdominal surgery on terms of surgical site infection. J Postgrad Med Inst. 2013;7:403–8.

Aziz I, Baloch Q, Zaheer F, Iqbal M. Delayed primary wound closure versus primary wound closure - a dilemma in contaminated abdominal surgeries. J Liaquat Uni Med Health Sci. 2015;14:110–4.

Bibi A, Bhutta D, Taimur M, Rahman BU, Ishtiaq S. A comparison of primary closure vs. delayed primary closure in contaminated abdominal surgery in terms of surgical site infection. IMJ. 2016;8(3):144–7.

Nasib G, Shah SI, Bashir EA. Laparotomy for peritonitis: primary or delayed primary closure? J Ayub Med Coll Abbottabad Jamc. 2015;27(3):543–5.

Singh PK, Saxena N, Poddar D, Gohil RK, Patel G. Comparative study of wound healing in primary versus delayed primary closure in contaminated abdominal surgery. Hell J Surg. 2016;88(5):314–20.

Siribumrungwong B, Chantip A, Noorit P, Wilasrumee C, Ungpinitpong W, Chotiga P, et al. Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis. Asian J Surg. 2014;37(3):120–4.

Sasikumar MN, Mammen SC. Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis. Int Surg. 2019;6:3708–14.

Agrawal V, Joshi MK, Gupta AK, Jain BK. Wound outcome following primary and delayed primary skin closure techniques after laparotomy for non-traumatic ileal perforation: a randomized clinical trial. Indian J Surg. 2017;79(2):124–30.

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Published

2021-06-28

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Original Research Articles