Abstract
Objective: Abdominal wall closure of an emergency laparotomy involves a great deal of consideration. An ideal laparotomy wound closure should be efficient. provide strength and serve as a barrier to infection. The aim of this study is to compare and evaluate the advantages of layered closure in comparison with the mass layered closure, the types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia. Methods: This prospective study was carried out over a period of 18 months enrolling a total of 90 patients split into two groups with group 1 undergoing mass closure using both interrupted and continuous methods and group 2 undergoing layered closure using both interrupted and continuous methods of suturing. Results: A higher rate of wound complications was noted in the layered closure group (37.7%) than the mass closure group (17%). Wound complications were also noted to be higher in closures done with prolene suture (37.7%) than PDS (20%). As far as techniques were concerned, interrupted and continuous suturing had a similar rate of complications. Of all the comorbidities, considered in the study, the highest rate of wound related complications were seen in patients with pulmonary complications (13.3%). Conclusion: Although the ideal way to close an abdomen post laparotomy has not yet been discovered, our study shows that mass closure with PDS suture to close the abdominal wall should be advocated as there is decreased early and late post operative wound complications Keywords: PDS.
Highlights
Laparotomy or celiotomy is a surgical procedure in which incision is put on abdominal wall in order to approach intraabdominal wall pathologies.[1]. In laparotomy, wisely chosen incisions and correct methods of making and closing such wounds are factors of great importance.[2]. Closure of emergency laparotomy wound involves a gamut of technical considerations yet suture material and closure techniques are a common denominator for all and it is performed in a multitude of fashions and there are an abundance of different tailored studies on this subject.[3]
The most widely utilized incision to access the intraabdominal pathologies is midline incision and it is very useful in emergency laparotomy as it is simple, quick and provides excellent exposure to every region of the abdominal cavity and retroperitoneum with minimal damage to neurovascular structures and muscles of the abdominal wall.[5,6]
The closure of the abdominal wall is of great importance because it impacts the outcome of the surgery.[5]. The ideal abdominal closure should be efficient, provide strength and serve as a barrier to infection.[7]. Closure of the midline abdominal incision have varied over time with better understanding of the physiology and engineering of closure of the abdominal wall and improvement in the materials of surgical sutures.[8]
Summary
Laparotomy or celiotomy is a surgical procedure in which incision is put on abdominal wall in order to approach intraabdominal wall pathologies.[1] In laparotomy, wisely chosen incisions and correct methods of making and closing such wounds are factors of great importance.[2] Closure of emergency laparotomy wound involves a gamut of technical considerations yet suture material and closure techniques are a common denominator for all and it is performed in a multitude of fashions and there are an abundance of different tailored studies on this subject.[3]. The present study will evaluate the advantages of layered closure in comparison with the mass layered closure, types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia.
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