Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency Laparotomy in Children

Khandoker Moynul Hasan,Mohammad Kamrul Ahsan,Md Ashraf Ul Huq,A K M Shahidur Rahman,Shahnoor Islam,Shah Md Rezaul Karim,Muhammed Moinul Huque,Mohammad Shafiul Azam,Md Iqbal Hossain Talukder,Sharmin Ara Begum

doi:10.4236/jbm.2020.88016

Abstract

Background: The value of laparotomy closure technique may be measured by the incidence of early and late wound complications. The best laparotomy closure technique should be less time consuming, easy and cost-effective, while preventing both early and late complications. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. Methods: This prospective comparative study was conducted at Department of Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2018. A total of 60 pediatric age cases that underwent laparotomy were included in this study. Cases were randomly allocated into two groups; 30 patients were in Group A (Layered closure) and 30 patients were in Group B (Mass closure). The outcome variables were time required for wound closure, wound infection, wound dehiscence and incisional hernia. Data were analyzed and compared by statistical tests. Results: The mean age of Group A and Group B patients were 31.08 ± 30.25 months and 34.70 ± 42.73 months respectively (p = 0.706). The ratio between male and female subject was 1.1:1 in Group A and 3.3:1 in Group B. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine due to blunt trauma respectively. Mean wound closure time was significantly less in mass closure group [28.20 ± 2.17 minutes in layered closure group and 18.80 ± 1.67 minutes in mass closure group, (p ≤ 0.001)]. Wound infection rate, incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, however, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively). There was no complete wound dehiscence in Group A, but that was in 1 (3.3%) patient in Group B (p = 0.313). Conclusion: Mass closure technique is comparatively better than layered closure technique.

Highlights

Laparotomy is a surgical procedure refers to a large incision through the abdominal wall that involves all layers to gain access into the abdominal cavity
Incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively)
Wound infection rate in mass closure group was 10% which was comparable with previous studies [17] [19]

Summary

Introduction

Laparotomy is a surgical procedure refers to a large incision through the abdominal wall that involves all layers to gain access into the abdominal cavity. It is a major surgical procedure, whether elective or emergency [1]. The choice of surgical incision to open the abdominal cavity should be based on patient’s condition, expertise of surgeon, or health care system criteria [2]. Surgeons’ main interests, aside from the elective or emergency exposure of the operative field are time required to open and close the abdomen, frequency of burst abdomen, incidence of wound infection, postoperative pulmonary complications and incisional hernias [2]. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine

Objectives

Methods

Results

Conclusion