Abstract
Midline laparotomy is frequently done in the emergency setting of any hospital and type of suture material used for the fascial closure of the abdominal wall influences the incidence of the postoperative complications. The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications. In addition, the effect of various risk factors on burst abdomen and wound infection was also evaluated. 
 Methods: 100 patients who have visited the emergency department of the hospital and underwent midline laparotomy were enrolled in this study.
 Results: Patients were divided into two groups depending on whether they have an intestinal perforation (group A, n=60) or intestinal obstruction (Group B, n=40). These two groups were further divided into two groups depending on the type of suture material used (plain Vicryl: group A1, B1 and medicated Vicryl: group A2, B2). Both these groups had an equal number of patients. The analysis of the data showed that compared to the non medicated suture material the rate of wound infection is considerably less in the cases of medicated polyglactin suture material. In addition, older age, diabetes, anemia, and malnutrition are the significant risk factor for wound infection (p<0.001s) while Older age, malnutrition, and cough were found to be highly significant risk factors for burst abdomen.
 Conclusion: The medicated suture material was proved to be more effective in preventing the burst abdomen and postoperative wound infections compared to the plain delayed absorbable Vicryl suture material.
 Keywords: delayed absorbable Vicryl, medicated Vicryl, burst abdomen, wound infection, a midline laparotomy
Highlights
IntroductionIn the midline laparotomy procedure, the weak, tendinous zone called linea alba is opened
Abdominal wall closure is a complex and dynamic process
The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications
Summary
In the midline laparotomy procedure, the weak, tendinous zone called linea alba is opened. The weakness of the linea alba is increased when the fibers are vertically sectioned [1]. The manipulation or closure of linea alba by suture requires the fibers within it to be subjected to mechanical tension. This mechanical force is best created when the fibers are vertically sectioned. In this process, the weakness of linea alba is increased and the access to the peritoneal cavity is eased. Different mechanical forces involved in the suturing process in combination with various biological factors play a determining role in the high incidence (16% to 20%) of postoperative incisional hernia [2]
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