Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases

Authors

  • Suchin S. Dhamnaskar Department of Surgery, Seth G. S. Medical College, King Edward the VII Memorial Hospital, Parel, Mumbai, India
  • Prashant C. Sawarkar Department of Surgery, Seth G. S. Medical College, King Edward the VII Memorial Hospital, Parel, Mumbai, India
  • Preeti Vijayakumaran Department of Surgery, Seth G. S. Medical College, King Edward the VII Memorial Hospital, Parel, Mumbai, India
  • Sumit Mandal Department of Surgery, Seth G. S. Medical College, King Edward the VII Memorial Hospital, Parel, Mumbai, India

DOI:

https://doi.org/10.18203/2349-2902.isj20163541

Keywords:

Contaminated surgeries, Continuous, Interrupted, Midline laparotomy fascial closure, Smead Jones method, Wound dehiscence

Abstract

Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure.

Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test.

Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p >0.05). Wound dehiscence rate was significantly less in the study group (p < 0.05) compared to control group.

Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.

References

Murtaza B, Khan NA, Sharif MA. Modified midline abdominal wound closure technique in complicated/ high risk laparotomies. J Coll Phys Surg Pak. 2010;20(1):37-41.

Malik AR, Scott NA. Double near and far prolene suture closure: a technique for abdominal wall closure after laparotomy. Br J Surg. 2001;88(1):146-7.

Robert E. Roses, Jon B. Morris. Incisions, closures and management of abdominal wound. Maingot’s Abdominal Operations. 12th Edition. The McGraw-Hill Companies Inc. 2012;99-120.

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

Principals of abdominal wall closure. Available at 19.3 : Sept 2011 http:// cursoenarm.net/ Up To Date. Accessed on 12 July 2016.

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

Israelsson LA, Jinsson T. Suture length to wound length ratio in healing laparotomy incisions. Br J Surg. 1993;80:1284-6.

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

Idris SA, Ali AQ, Shalayel MH, Idris TA. Design of multicentre study to evaluate frequency and risk factors for wound dehiscence/ burst abdomen: a study of 1683 major midline laparotomies. Sudan Med Monitor. 2010;5(4):185-91.

Riet VM, Steyrberg EW, Nellensteyn J, Bonjer HJ. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89:1350-6.

Weiland DE, Bay C, Sordi DS. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176:666-70.

Rath AM, Chervel JP. The healing of laparotomies: a review of literature. part 1. physiologic and pathologic aspects. Hernia. 1998;2:145-69.

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

Elkheir IS, Idris SA. Evaluation of abdominal wall closure techniques in emergency laparotomies at a peripheral hospital. Sch J App Med Sci. 2014;2(5):1591-5.

Gallop DG, Talledo OE, King LA. Primary mass closure of midline incisions with continuous runnig monofilament suture in gynaecological patients. Obst Gynaecol. 1989;73:675-7.

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

Van OJM, Lange JF, Goossens RH, Koster RP. Artificial midline fascia of human abdominal wall for testing suture strength. J Master Sci Med. 2006;17:759-65.

Kiely EM, Spitz L. Layered versus mass closure of abdominal wall in infants and chidren. Br J Surg. 2002;72:739-40.

Wissing J, Vroonhoven TJ, Schattenkerk ME, Veen HF. Fascia closure after midline laparotomy- results of randamised trial. Br J Surg. 1987;74:738-41.

Khan MN, Naqvi AH, Irshad K. Frequency and risk of abdominal wound dehiscence. J Coll Physic Surg Pak. 2004;14:355-7.

Cushieri A. Disorders of abdominal wall and peritoneal cavity In: Cushieri A, Steele JC, Moosa ar. Essential surgical practise: higher surgical training in general surgery. 4th edition. London: Hodder Arnold Publishers. 2002:169-70.

Bennett DH, Kingsnorth AN. Hernias, umbilicus and abdominal wall. In: Russel RCG, Williams NS, Bulstrode CJK. Bailey and love’s short practise of surgery. 24th edition. London: Hodder Arnold Publishers. 2004:1290-1.

Zabd A, Rehman ETAL. Comparison of wound dehiscence in interrupted with continuous closure of laparotomy. Pak J Med Health Sci. 2013;7(3):826-9.

Saxe JM, Ledgerwood AM. Management of difficult abdominal closure. Surg Clin North Am. 1993;73;243.

Knabel H, Koch M, Sauderland S, Diener MK, Markus W. Interrupted or continuous slowly absorbable sutures- design of multicentric randomised trial to n evaluate abdominal wall closure technique insect trial. British Med J Surg. 2005;5:3.

Cruse PJ, Foord R. Five year prospective study of 23649 surgical wounds. Arch Surg. 1973;107:206-10.

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Published

2016-12-10

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Original Research Articles