A comparison between mass closure and layered closure of midline abdominal incisions

Abstract

<b>Background:</b> Traditionally, a laparotomy wound is closed in layers co-opting the various layers anatomically. A new method of closure, namely single layer closure technique (mass closure technique) has come into vogue. <b>Aims:</b> This study aims to evaluate the benefits or otherwise between single layer closure and layered closure after comparing it with studies available in literature. <b>Settings and Design:</b> This study was performed in a teaching institute in patients undergoing laparotomy, either planned or emergency. <b>Materials and Methods:</b> A total of 80 cases were selected at random and the study was carried out over a period of 2 years. The cases were equally divided into two groups of 40. In both groups, vertical midline incision was used. In the first group, abdomen was closed using the single layer closure technique. Continuous suturing with burial of the knots was done in 20 patients and interrupted mass closure was done in another 20 patients. In the other group, the abdomen was closed in layers. The patients were followed up for minimum 6 months. Patients who did not turn up for follow up were asked to notify the development of any wound complication through postal correspondence. <b>Results:</b> The time required for closure was considerably less when continuous suture technique was used. One patient in the mass closure group and four in the layered group developed post-operative wound infections. One patient in the layered closure group developed a stitch sinus. There were two cases of burst abdomen with the layered closure technique. Two patients in the layered closure group developed incisional hernias 6 months post-operatively. <b>Conclusions:</b> Single layer closure technique offers certain definite advantage over the layered closure technique with respect to the time required for closure of the incision, incidence of wound dehiscence and the incidence of incisional hernia. However, the true incidence of wound dehiscence (burst abdomen) and incisional hernia cannot be drawn since the study was of short duration and the number of cases was small without a long follow up.