A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

Authors

  • Rahul D. Kunju Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Vinayak Thakkannavar Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Shrivathsa Merta K. Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Sachin H. G. Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Allen Netto Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Suraj J. Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Praveen M. Pawar Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20172403

Keywords:

Continuous, Emergency laparotomy, Fascial closure, Intermittent

Abstract

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.

Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.

Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.

Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

References

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.

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.

Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: The INLINE systematic review and meta-analysis. Ann Surg 2010;251(5):843-56.

Chalya PL, Massinde AN, Kihunrwa A, Mabula JB. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Res Notes. 2015;8(1):281.

Ashish S, Hitendra D. Continuous versus interrupted sutures in laparotomy closure: a comparative study. Ind J Res. 2016:5(5):317-8.

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Published

2017-05-24

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Section

Original Research Articles