Primary abdomen closure (using sheath relaxation) versus staged closure (using modified Bogota) following laparotomy in secondary peritonitis: a comparative study

Anupam Das, Ajay Kumar Singh


Background: Primary closure or open laparostomy after laparotomy for peritonitis have their own morbidities. In this study, rectus sheath relaxation was used as an alternative to conventional primary closure and compared to the modified Bogota technique in patients of peritonitis.

Methods: We included 60 patients of peritonitis with two of the following criteria: APACHE II score 10-20, Mannheim peritonitis index (MPI) 20-30 or post-resuscitation intraabdominal pressure (IAP) >15 mmHg and randomized them to group A (Sheath relaxation technique) and group B (modified Bogota). Outcome criteria studied included procedure failure, complications, pain, mortality and duration of ICU and hospital stay.

Results: Both groups were comparable in terms of age, gender, inclusion criteria, ICU stay and mortality. The success rate in group A was 63.33% while in group B, was 53.33% with complication rates of 37% and 46.67% respectively. The pain and duration of hospital stay were significantly less in group A.

Conclusions: We concluded that primary abdomen closure using rectus sheath relaxation in select patients was an easy, feasible and better alternative than the staged closure using modified Bogota technique following laparotomy in patients of severe secondary peritonitis. Patients with higher APACHE II and MPI scores may be better managed primarily by modified Bogota technique, while those with lower APACHE II and MPI do well with primary closure with sheath relaxation. The pre- operative APACHE II, MPI and post resuscitation IAP either individually or in combination, could, therefore, predict the wound failure rates, choice of closure techniques.


Bogota, Peritonitis, Sheath relaxation

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