PROSPECTIVE CLINICAL STUDY: MASS CLOSURE VERSUS LAYER CLOSURE OF ABDOMINAL WALL

Abstract

Background: Most common abdominal wall incisions are midline or paramedian and its closure technique should be efficient to provide strength for prevention of incisional hernia and should be a barrier to infection. Incisional hernia is commonest complication as high as 39.9 % after abdominal surgery. Integrity of sutured abdominal wound rests on balance between suture holding capacity of tissues and tissue holding capacity of sutures (1). Objective: objective of study is evaluate comparison between mass closure and layered closure of midline and paramedian incisions for operative time and postoperative complications after performing single layered closure and conventional layered closure of laparotomy wounds like seroma ,wound infection ,wound gaping ,burst abdomen and incisional hernia. Results : Meantime for closure of laparotomy wound through midline or Para median incision by single layered closure technique was 14 minutes and by layered closure technique was 23 minutes . There was difference of 9 minutes statistically significant (p=0.001). In postoperative period patients closed by mass closure technique 8 patients(16%) had postoperative complications in the form of seroma in 2 patients(4%), infection in 3 patients(6%), wound gaping in 2 patients(4%) and incisional hernia in 1 patient(2%)and no patient had burst abdomen where as in layered closure total 16(32%) patients had complications as seroma in 5 patients(10%) ,wound infection in 4 patients(8%)., gaping in 4 patients(8%) burst abdomen in 1 patient (2%) and incisional hernia in 2 patients(4%). Conclusion: Single layered closure technique is better than layered closure in term of operation time and postoperative complications like seroma, infection, wound gaping, burst abdomen and incisional hernia.