Early Exposure vs Delayed Exposure of Postoperative Wounds in Elective Inguinal Hernia Surgery: A Longitudinal Study

Abstract

Introduction: Wounds and their management are fundamental aspects of the practice of surgery. A closed wound that heals in a timely fashion is considered to be a good indicator of surgical intervention. Many experimental studies have shown that precisely sutured incision with good haemostasis gets sealed with fibrin within 6 to 24 hours and the wound becomes adequately protected from outside moisture. Hence, early exposure to clean surgical wounds would be a cost-effective measure, especially in a resource-poor country like ours by avoiding unnecessary dressings for a long period of time. Aim: To assess the effectiveness of early exposure (24 hours) and delayed exposure (72 hours) in wound management after elective inguinal hernia surgery. Materials and Methods: A longitudinal study was conducted in the Department of General Surgery of Government Medical College, Kottayam, Kerala, India from September 2020 to August 2021. All elective cases (n=200) posted for inguinal hernia of age more than 18 years were consecutively allocated to two groups, group A early exposure of surgical wound site and group B delayed exposure. The wound site examination, on the third day along with white blood cell count was assessed. Wound site examination on 7th day and 30th postoperative day and length of hospital day were recorded. Southampton wound grading system was used for recording healing parameters. All data was described using means for continuous variables and percentages for categorical variables Chi-square test was used for categorical variables with significance level at p<0.05. Results: Out of the 200 patients studied, 92 (92%) were males in group A and 94 (94%) of them were males in group B. The wound contamination in those patients where postoperative dressing was removed after 24 hours (group A) and 72 hours (group B), it was found that majority of patients had wound Grade-0 irrespective of dressing i.e., 96% and 97%, respectively (p-value=0.395) with reference to wound condition on postoperative day 7. In group A patients had (96 cases in 0-10 days) compared to group B (97 cases in 0-10 days) although statistically, it was not significant (p-value >0.05). Conclusion: There is not much difference in wound healing and incidence of surgical site infection in patients, whose wounds were kept open 24 hours after surgery when compared to those, whose wounds were dressed daily for the next two days consecutively.