PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

Abstract

Background :Burst abdomen is a major complication associated with contaminated or dirty surgeries, including emergency midline laparotomy. Possible causative factors involve wound sepsis, patients’ overall pressure inside the abdomen, and many system problems. Conventional oncosurgical approaches could prove inadequate, leading to evaluation of preventive methods, such as DTS, of minimizing such adverse outcomes. Objectives :To evaluate the level of success of deep tension suturing done before the primary closure of the abdomen against formation of burst abdomen, wound infection, and incisional hernia than mass closure techniques. Study design: A Cross sectional study. Place and duration of study. This Cross Sectional study was carried out at Setting: Done at Ziauddin Hospital, Civil Hospital- ward 06, and PAF Hospital, Karachi from Change the dates in duration of study as follows: January 2019 to Jan 2022 Methods: A Cross Sectional study which involved 100 adults who were posted for emergency midline laparotomy due to generalized peritonitis. Patients were divided into two groups: Group A: conventional mass closure Group B: closure with DTS. Both groups received simple polypropylene sutures for wound closure as in the standard mesh repair technique but not in group B they also received four deep tension sutures using the rubber tubing to distribute tension over wider areas of the tissue. Patients with diabetes, immunosuppression, or use of corticosteroids were excluded as a result. Results The age in years of the participants was 31.61 ± 9.31 years; the maximum age was 61 years, the minimum was 18 years. The observation was made that the incidence of burst abdomen in Group B was 4 and that of Group A was 18 (p<0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p<0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p<0.05. These outcomes show decreases in all of the primary complications when implementing DTS on the approaches as there were statistically significant improvements for all of them. Conclusion :The pro-active use of deep tension sutures in emergency midline laparotomy dramatically decreases the rate of burst abdomen, wound infection, and incisional hernia. As tension on the wound edges is reduced by DTS, the study shows that postoperative complications are preventable in high-risk surgeries, patient benefits maximized, and reoperations minimized.