OUTCOME OF THE CHOICE OF WOUND CLOSURE TECHNIQUE IN EMERGENCY LAPAROTOMY
AbstractBackground: Abdominal surgeries are the most common surgeries performed around the world. Closure of abdominal wound is important and a number wound closing techniques are in practice. This study was conducted to determine the outcome of the choice of wound closure technique in emergency laparotomy. Methods: It was a retrospective study from March–September 2019, conducted at the Surgical A unit, Ayub Teaching Hospital, Abbottabad. Ninety-five patients aged 22–60 years, who underwent emergency laparotomies via midline and para-median incisions were included in the study. Results: There were 74 (77.89%) males and 21 (22.11%) females. Anatomical closure technique was used in 67 (70.53%) of study participants while mass closure technique was used in 28 (29.47%) of study participants. 50 (52.63%) patients had anaemia, 27 (28.42%) had hypo-proteinemia, and 14 (14.74%) developed peritonitis. Post-operative wound infection was noticed in 15 (15.79%) patients. Out of 95 patients, 19 (20%) developed burst abdomen. Overall, 5 (5.26%) patients died in the hospital. All cases of burst abdomen occurred within first two weeks of hospital stay (p= 0.004), had an association with peritonitis (p=0.0001) and post-operative wound infection (p= 0.005). Wound closure technique was not associated with development of post-operative complications including burst abdomen (p >0.05). Conclusion: Post-operative complications occur independently of wound-closure technique and surgeons should have a low threshold for prevention of post-operative complications where possible.
Hanumanthappa B, Hebsur NI. Clinical Study on Assessment of Post-Surgical Complications According to Clavien–Dindo Classification after Major Abdominal Surgery. IJSS J Surg 2018;4(4):1–6.
Weiland DE, Bay RC, Del Sordi S. Choosing the best abdominal closure by meta-analysis. Am J Surg 1998;176(6):666–70.
Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg 2001;67(5):421–6.
Banerjee P, Chatterjee A. Critical evaluation of conventional abdominal closure with single-layer closure in adult and elderly. J Indian Med Assoc 1989;87(12):277–8.
Khan MA, Akhtar N, Buzdar MU. Comparison between Mass Closure and Layered Closure in Major Abdominal Laparotomies. Pak J Med Health Sci 2015;9(3):962–5.
Tocchi A, Liotta G, Mazzoni G, Lepre L, Costa G, Agostini N, et al. Layered and mass sutures in the closure of median laparotomies. G Chir 2000;21(11–12):463–8.
Seid MH, McDaniel-Owens LM, Poole GV, Meeks GR. A randomized trial of abdominal incision suture technique and wound strength in rats. Arch Surg 1995;130(4):394–7.
Chawla S. A comparison between mass closure and layered closure of midline abdominal incisions. Med J Dr Patil Univ 2012;5(1):23–6.
Bansal A, Mallick M, Jena S. A study of post-operative complications of all emergency laparotomy in a tertiary care hospital within 90 days. Arch Clin Gastroenterol 2019;5(2):15–8.
Chauhan S, Sharma H, Chauhan B. Assessment of post-operative complications in emergency abdominal surgery in a tertiary care centre. Sch J App Med Sci 2017;5(4E):1581–87
Dhaigude BD, Shree S, Shah P, Francis M, Patel K, Metta V. Post-operative wound complications following emergency and elective abdominal surgeries. Int Surg J 2018;5(1):232–37
Bewes P. Abdominal closure. Trop Doct. 2000;30(1):39–41.
Soni P, Haripriya VB, Haripriya A, Dutt V. Burst Abdomen: A Post-operative Morbidity. Int J Sci Study 2015;3(6):175–8.
Amini AQ, Khan NA, Ahmad J, Memon AS. Management of abdominal wound dehiscence: still a challenge. Pak J Surg 2013;29(2):84–7.
Rashid MHA, Shaha LK, Shashi SS, Faruk I. Risk Factors of Burst Abdomen in Emergency Laparotomy. Bangladesh Med J 2019;46(2):38–42.
Jaiswal NK, Shekhar S. Study of burst abdomen: it’s causes and management. Int Surg J 2018;5(3):1035–40
Niggebrugge AH, Hansen BE, Trimbos JB, van de Velde CJ, Zwaveling A. Mechanical factors influencing the incidence of burst abdomen. Eur J Surg 1995;161(9):655–61.
Khan MN, Naqvi AH, Irshad K, Chaudhary AR. Frequency and risk factor of abdominal wound dehiscence. J Coll Physicians Surg Pak 2004;14(6):355–7.
Deshmukh SN, Maske AN. Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study. Int Surg J 2018;5(2):584–7.
Maruthi CH, Katari A. A comparative study of the outcome of Mass Closure and Layered closure techniques for Midline Abdominal Incisions in a Teaching Hospital. J Med Sci Clin Res 2018;7(10):255–61.
Ellis H, Heddle R. Closure of the abdominal wound. J R Soc Med 1979;72(1):17–8.
Kendall S, Brennan T, Guillou P. Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions. Br J Surg 1991;78(6):705–7.
Murtaza B, Khan NA, Sharif MA, Malik IB, Mahmood A. Modified midline abdominal wound closure technique in complicated/high risk laparotomies. J Coll Physicians Surg Pak 2010;20(1):37–41.
Khan NA, Almas D, Shehzad K, Chaudhry AK, Mian MA. Comparison between delayed–absorbable polydioxanone and non-absorbable (prolene) suture material in abdominal wound closure. Pak Armed Forces Med J 2009;59(1):64–9.
Hegazy T, Soliman S. Abdominal wall dehiscence in emergency midline laparotomy: incidence and risk factors. Egypt J Surg 2020;39(2):489–97.
Lakshmi G, Ravimohan TR. Post Laparotomy Abdominal Wound Dehisence – A Study in Tertiary Care Hospital. Int J Contemp Med Res 2018;5(11):K1–5.
Israelsson L, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 1993;80(10):1284–6.
Waqar SH, Malik ZI, Razzaq A, Abdullah MT, Shaima A, Zahid MA. Frequency and risk factors for wound dehiscence/burst abdomen in midline laparotomies. J Ayub Med Coll Abbottabad 2005;17(4):70–3.
Bhavikatti GS, GHV RG. Comparative Study of Mass Closure and Layered Closure Techniques in Midline and Paramedian Laparotomies. Acad J Surg 2019;2(1):42–6.
Chhabra P, Maheswari M, Kumar D. A comparison between mass closure and layered closure in laparotomy wounds. Int J Med Health Res 2019;6(2):8–11.