Emergency Midline Laparotomy Research Articles

Comparison of continuous versus modified continuous SMEAD jones “far-near-near-far” suturing technique for abdominal wall closure in emergency midline laparotomy wound in terms of wound dehiscence.

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method.

Evaluation of Negative Pressure Dressings for Closed Surgical Incisions in Decreasing Surgical Site Infections After Emergency Laparotomy: A Randomized Controlled Study.

Objectives The aim of this study is to compare the effectiveness of negative pressure dressings (NPDs) versus conventional dressings for closed surgical incisions after emergency midline laparotomy, focusing on their impact on surgical site infection (SSI) rates, wound dehiscence, hospital stay duration, and cosmetic outcomes. Methods The randomized controlled study was conducted over 24 months, involving 80 patients aged 18-65 years who had peritonitis and underwent emergency midline laparotomies. Patients with diabetes mellitus, a BMI >35 kg/m², immunocompromised conditions, or those requiring re-exploration within 30 days of surgery were excluded. The participants were randomly assigned into two groups using a computer-generated randomization table: Group A, the case group, consisted of 40 patients who received NPDs, while Group B, the control group, included 40 patients who received conventional dressings. Data were recorded in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with a p-value of <0.05 considered statistically significant. Results The overall occurrence of SSIs within the 30-day follow-up period was significantly lower in the NPD group compared to the conventional dressing group (30% vs. 70%, p < 0.05). The mean duration of hospital stay was 14.85 ± 10.43 days for the NPD group and 15.4 ± 9.75 days for the control group, with no statistically significant difference (p = 0.712). The mean Vancouver Scar Scale score was 5.3 ± 2.47 in the NPD group and 6.5 ± 2.14 in the control group, also showing no statistically significant difference (p = 0.11). Conclusions NPDs significantly reduced the incidence of SSIs compared to conventional dressings, but they did not have a significant impact on scar cosmesis or the duration of hospital stay.

The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study

PurposeThe emergency midline laparotomy is a commonly performed procedure with a burst abdomen being a critical surgical complication requiring further emergency surgery. This study aimed to investigate the clinical outcomes of patients with burst abdomen after emergency midline laparotomy.MethodsA single-center, prospective, observational cohort study of patients undergoing emergency midline laparotomy during a two-year period was done. Abdominal wall closure followed a standardized technique using monofilament, slowly absorbable suture in a continuous suturing technique with a suture-to-wound ratio of at least 4:1. Treatment of burst abdomen was surgical. Data, including intra-hospital postoperative complications, were collected and registered chronologically based on journal entries. The primary outcome was to describe postoperative complications, length of stay, and the overall morbidity based on the Comprehensive Complication Index (CCI), stratified between patients who did and did not suffer from a burst abdomen during admission.ResultsA total of 543 patients were included in the final cohort, including 24 patients with burst abdomen during admission. The incidence of burst abdomen after emergency midline laparotomy was 4.4%. Patients with a burst abdomen had a higher total amount of complications per patient (median of 3, IQR 1.3–5.8 vs. median of 1, IQR 0.0–3.0; p = 0.001) and a significantly higher CCI (median of 53.0, IQR 40.3–94.8 vs. median of 21.0, IQR 0.0–42.0; p = < 0.001).ConclusionPatients with burst abdomen had an increased risk of postoperative complications during admission as well as a longer and more complicated admission with multiple non-surgical complications.

Hughes Abdomen Closure Technique Versus Continuous Closure in Emergency Midline Laparotomy: A Randomized Controlled Study.

Background Abdominal wound dehiscence, a serious postoperative issue, remains a significant concern for surgeons due to its potential to increase patient mortality and morbidity. Disruption can occur at any point after surgery, sparking debate over the optimal closure method for midline vertical abdominal wounds. Therefore, it's crucial to determine the safest approach. Our randomized clinical trialis plannedtocompare the risk of a burst abdomen associated with the Hughes abdominal closure technique to that of continuous abdominal closure. Methods All patients >18 years scheduled for emergency midline laparotomy were randomly assigned into two groups using computer-generated random numbers: Group A underwent Hughes repair (12 patients) and Group B underwent continuous closure(17 patients). Preoperative data, including patient demographics, and postoperative outcomes, such as time for rectus closure, wound dehiscence, surgical site infection (SSI), and length of hospital stay, were documented for analysis. Results The study found that the average patient age was 37.89 years, with more males than females. Both groups had an equal distribution of co-morbidities (p = 0.468), but none of these factors were statistically significant. Burst abdomen occurred in 25% of group A and 41.1% of group B (p = 0.367, not significant). Incisional hernia was absent in both groups. Surgical site infection (p = 0.119) and respiratory complications (p = 0.16) were not statistically significant between groups. However, in group A, theregressive analysis showed significant associations between burst abdomen, surgical site infection (p = 0.018), and respiratory complications (p = 0.007), whilein group B, these associations were not significant (p = 0.252 for SSI and p = 0.906 for respiratory complications). Conclusion The occurrence of burst abdomen and closure time differences between continuous and Hughes techniques were not significant. The Hughes technique was quicker to learn (32 vs. 22 minutes). Burst abdomen was more common in continuous closure (group A: 25% vs. group B: 41%), favoring the Hughes technique. Factors like age, gender, and others didn't significantly impact the burst abdomen in either group.

Evaluation of possum score for outcome prediction in patients undergoing emergency midline laparotomy in tertiary health care center of central India: A prospective observational study

Evaluation of possum score for outcome prediction in patients undergoing emergency midline laparotomy in tertiary health care center of central India: A prospective observational study

Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: a randomized controlled trial [NCT00544583

BackgroundHigh-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy.Methods/designCONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up.ResultsFrom August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04–1.32).ConclusionThis RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.

Comparative study between mass closure suturing technique and Hughes repair in emergency midline laparotomies

Comparative study between mass closure suturing technique and Hughes repair in emergency midline laparotomies

Comparison between conventional and modified Smead Jones method for abdominal mass closure in emergency midline laparotomy

Comparison between conventional and modified Smead Jones method for abdominal mass closure in emergency midline laparotomy

PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

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&lt;0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p&lt;0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p&lt;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.

Comparison between Interrupted X Suture and Continuous Suture for Closure of Midline Incision in Emergency Laparotomy : A Randomized Controlled Trial

Background: Wound dehiscence is disruption of any or all of the layers in a wound. At around 7–10 days post operatively leakage of clear sero-sanguinous fluid from the wound is usually the first indicator of burst abdomen. The patient usually feels something ‘giving away’ at this time.It may occur in 3-14.5% cases and is very distressing to the patient.Number of methods of closure of midline laparotomy wound have been introduced in the past to prevent this outcome. The study to compare the result of continuous and interrupted closure of midline emergency laparotomy in respect of burst abdomen.&#x0D; Materials and methods: This randomized controlled trial study was carried out in the Department of Surgery Chittagong Medical College Hospital, Chattogram, duration January 2017 to December 2017. A total of 500 patients were enrolled in this study. Data were collected, statistical analyses were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-23).&#x0D; Results: 250 patients in group A and 250 in B. Surgical wound related post-operative complications were found in 30.4% of the study subjects (n=152).Wound dehiscence was found in 11% subjects, surgical site infection was found in 18.4% subjects and incisional hernia in 1%.All these complications were significantly higher in continuous suture group than interrupted group (p&lt;0.001).Wound dehiscence in 20 subjects, treated with interrupted sutures and in 40 subjects (35 wound dehiscence and 5 incisional hernia)treated with continuous suture. The Relative Risk (RR) of developing wound dehiscence post-operatively was found to be 0.63 (95% CI 0.33 – 0.72) for interrupted suture. This was statistically significant (p&lt;0.05).&#x0D; Conclusion: The interrupted X suture technique is better than continuous suture technique in prevention of burst abdomen in emergency midline laparotomy.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 52-56

Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case-control study.

Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. A single-center, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis. A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls; p = < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71-5.47; p = < 0.001). No other suspected risk factors showed a significant association with burst abdomen. Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.

A study on clinical profile and risk factors in incisional hernia patients

Incisional hernias of the abdominal wall are a frequently encountered complication in cases of open abdominal surgeries like midline laparotomies, caesarian sections etc. Wound infections, obesity, poor healing due to malnutrition etc., were thought to be the important causative factors in the development of incisional hernia.To study the clinical profile of incisional hernia patients with respect to various etiological factors, distribution of cases in relation to age and sex, details of previous surgical procedures undergone.52 patients admitted in Department of General Surgery were included in the study. Study was conducted during the period from August 2018 to August 2020 including all patient with incisional hernia. Pediatric cases were excluded from the study. Data of all the patients were collected from the hospital records and were compiled in a predesignated proforma which included patient details, clinical examination, investigations, and previous surgical history. Informed consent was obtained from each patient. Retrospective observational study. There were 32 females (61.54%) and 20 males (38.46%) with female to male ratio was found to be 1.6:1. Majority of the patients presented with abdominal swelling (n=30, 58%) followed by both abdominal swelling and pain (n=20, 38%). Among the females now presented with incisional hernias the mean parity was 2.69. Majority of the cases developed hernias within 1 year (n=29, 55.77%) and about 26.93% of the patients developed hernia in 1 to 3 years. Most of cases of incisional hernia in our study occurred over midline (n=22, 42.3%) at the site of incisions made for midline laparotomy (n=20.38.5%) Risk factors favouring incisional hernia formation were post-operative wound infection (n=45, 84.9%) and obesity (n=21, 40.38%). Incisional hernia is more common in females who undergo emergency midline laparotomy and emergency caesarean section. Majority of the cases presented within 1 year of surgery. Post-operative wound infection, obesity and anemia were the crucial factors for the development of incisional hernias.

Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Bilateral Rectus Sheath Block With That of Local Anaesthetic Infiltration in Patients Undergoing Emergency Midline Laparotomy Surgeries: A Randomised Controlled Trial.

Purpose Rectus sheath block (RSB) is increasingly utilised as a part of multimodal analgesia in laparotomy surgeries. We proposed this study to compare the analgesic efficacy of ultrasound-guided bilateral RSB with local anaesthetic (LA) infiltration. The primary outcome was the visual analogue scale (VAS) at rest and cough. The secondary outcomes were the postoperative morphine consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV)and patient satisfaction score. Methods In our prospective, single-centre, randomised clinical trial, we enrolled a total of 100 patients undergoing emergency midline laparotomy surgeries. They were randomly allocated into two groups and were administered either LA infiltration (group L, n=50) or ultrasound-guided bilateral RSB (group R, n=50) with 15-20 ml of 0.25% bupivacaine end operatively.The categorical and ordinal variables were analysed using Chi-square/ Fisher's exact test. The continuous and discrete variables were analysed using Mann-Whitney/independent Student t-test. Results The median VAS scores in the postoperative period were significantly lower with RSB when compared with LA. Statistically significant differences in median VAS scores were noticed at one hour (P<0.001), four hours (P=0.001), eight hours (P<0.001), and 12 hours (P=0.014) at rest, and at one hour (P<0.001), four hours (P<0.001) and eight hours (P<0.001) during cough.The median morphine consumption was less with RSB (P<0.001). The time to first rescue analgesia was prolonged with RSB (P<0.001). The incidence of PONV was significantly lower with RSB (P=0.027). Conclusion Bilateral ultrasound-guided RSB provides extended postoperative analgesia at rest and cough for patients undergoing emergency laparotomy surgeries when compared with LA infiltration. There was a significant reduction in morphine consumption, incidence of PONV, and prolonged time to first rescue analgesia with RSB.

Continuous and interrupted abdominal-wall closure after primary emergency midline laparotomy (CONIAC-trial): study protocol for a randomised controlled single centre trial

IntroductionThe optimal closure of the abdominal wall after emergency midline laparotomy is still a matter of debate due to lack of evidence. Although closure of the fascia using a continuous,...

Abdominal subcutaneous obesity and the risk of burst abdomen: a matched case-control study.

The causes of burst abdomen after midline laparotomy remain uncertain. Obesity is a suspected risk factor. The purpose of this study was to investigate the association between abdominal subcutaneous obesity (ASO) and burst abdomen in patients undergoing emergency midline laparotomy. We conducted a single-centre, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021. Patients suffering from burst abdomen were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. ASO was defined as the highest sex-specific quartile (≥ 75%) of subcutaneous fat layer evaluated on CT. The primary outcome was the association between ASO and burst abdomen, stratified between cases and controls. Secondary outcomes included 30- and 90-day mortality, length of stay, and suspected risk factors of burst abdomen, assessed by multivariate analysis across cases and controls. A total of 475 patients were included in this study, with 95 cases matched to 380 controls. Liver cirrhosis, active smoking, and high alcohol consumption were more common among cases in an unadjusted analysis. Liver cirrhosis (odds ratio (OR) 3.32, p = 0.045) and active smoking (OR 1.98, p = 0.009) remained significant in a multivariate analysis and were associated with burst abdomen. One hundred twenty-four patients had ASO. ASO was not significantly associated with burst abdomen (OR 1.11, p = 0.731). ASO was not found to be associated with an increased risk of burst abdomen after emergency midline laparotomy.

Prophylactic mesh placement in emergency midline laparotomy for intestinal perforation peritonitis: An appeal for caution.

Prophylactic mesh placement (PMP) is increasingly being used to reduce the incidence of incisional hernia after routine and emergency midline laparotomy (EML). However, such studies are not available for EMLs done solely for intestinal perforation. Patients who underwent non-absorbable PMP during EML for intestinal perforation (Group A, 15 patients) were compared with those who had a conventional abdominal wall closure (Group B, 20 patients). The incidence of wound dehiscence was significantly higher in Group A, while surgical site infection (SSI), and incisional hernia were similar in both groups. Mesh explantation was needed in half the cases. A prophylactically placed non-absorbable mesh in patients undergoing EML for intestinal perforation is associated with significantly higher rates of wound dehiscence and of mesh explantation and therefore, routine use of such a mesh appears not to be justified.

"Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case-control study".

Burst abdomen is a serious complication commonly observed after emergency midline laparotomy. Sarcopenia has been associated with increased morbidity and mortality after abdominal surgery. This single-center, retrospective, matched case-control study aimed to investigate the association between sarcopenia and burst abdomen in patients undergoing emergency midline laparotomy. Patients who had burst abdomen after emergency midline laparotomy were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. CT assessed psoas cross-sectional area was used as a surrogate measure of sarcopenia. Sarcopenia was defined as the sex-specific lowest quartile of psoas cross-sectional area adjusted for body surface area. The primary outcome was the incidence rate of sarcopenia amongst cases and controls. Secondary outcomes were risk factors for burst abdomen and death that were identified using multivariate logistic regression analysis. 67 cases were matched to 268 controls during May 2016-December 2019. BMI > 30kg/m2, liver cirrhosis, smoking, high ASA score and peritonitis were more frequently observed among cases. Multivariate analysis revealed that sarcopenia (odds ratio (OR) 2.3, p = 0.01), active smoking (OR 2.3, p = 0.006) and liver cirrhosis (OR 3.7, p = 0.042) were significantly associated with burst abdomen. ASA score ≥ 3 (OR 5.5, p = 0.001) and ongoing malignant disease (OR 3.2, p = 0.001) were significantly associated with increased 90-day mortality. Sarcopenia is associated with increased risk of burst abdomen after midline laparotomy. Prospective trials are needed.

Prophylactic retrorectus mesh versus no mesh in midline emergency laparotomy closure for prevention of incisional hernia (PREEMER): study protocol for a multicentre, double-blinded, randomized controlled trial

BackgroundDespite the fact that emergency midline laparotomy is a risk factor for an incisional hernia, active research on hernia prevention in emergency settings is lacking. Different kinds of meshes and mesh positions have been studied in elective abdominal surgery, but no randomized controlled trials in emergency settings have been published thus far.MethodThe PREEMER trial (registration number NCT04311788) is a multicentre, patient- and assessor-blinded, randomized controlled trial to be conducted in six hospitals in Finland. A total of 244 patients will be randomized at a 1 : 1 ratio to either the retrorectus mesh group, featuring a self-gripping prophylactic mesh, or to the no mesh (control) group, both closed by small-stitch 4 : 1 closure with continuous slowly absorbable monofilament suturing. The primary outcome of the PREEMER trial is the incidence of incisional hernia 2 years after surgery, which will be detected clinically and/or radiologically. Secondary outcomes are the Comprehensive Complication Index score, incidence of surgical-site infections and fascial dehiscence within 30 days of surgery; the incisional hernia repair rate and mesh- or hernia-related reoperations within the 2- and 5-year follow-ups; the incidence of incisional hernia within the 5-year follow-up; and quality of life measured by RAND-36, the Activities Assessment Scale and the PROMIS questionnaire within 30 days and 2 and 5 years from surgery. Additionally, health–economic explorative measures will be explored.ConclusionThe PREEMER trial will provide level 1 evidence on incisional hernia prevention in an emergency setting.Registration numberNCT04311788 (http://www.clinicaltrials.gov). Registered 7 March 2020.

Closure of Emergency Midline Laparotomy over Subcutaneous Closed Suction Drain to Mitigate Incisional Surgical Site Infection, Dehiscence and Hernia: A Prospective Comparative Study

Closure of Emergency Midline Laparotomy over Subcutaneous Closed Suction Drain to Mitigate Incisional Surgical Site Infection, Dehiscence and Hernia: A Prospective Comparative Study

A Comparative Study Using Interrupted Figure of Eight Suture Versus Conventional Continuous Suturing for Closure of Emergency Midline Laparotomy

Wound infections continue to represent a major medical problem, both in terms of how they affect the outcome of surgical procedures (surgical site infections), and for their impact on the length of hospital stay and medical costs. Many otherwise successful surgical operations fail because of the development of wound infections. A major SSI is defined as a wound that either discharges significant quantities of pus spontaneously or needs a secondary procedure to drain it Wound infection predisposes the patient to wound dehiscence. Acute wound failure is defined as postoperative separation of the abdominal musculoaponeurotic layers, within 30 days after operation. Most surgical wound infections become apparent within 7 to 10 days postoperatively. Objectives of the study 1. To assess local wound complication in emergency midline laparotomy wounds with interrupted figure of eight technique over conventional continuous closure . 2. To Compare the operative time for interrupted figure of eight closure and Conventional layered closure of laparotomy wounds. 3. To determine the factors affecting wound dehiscence. Materials and Methods: A prospective study was performed at Victoria hospital and Bowring and Lady Curzon hospital , Bangalore during November 2017 – May 2019. A sample of 100 cases were considered. Each Group consisted of 50. Group 1 underwent Interupted figure of Eight suture technique and Group 2 underwent continuous conventional suturing technique. Results: The incidence of burst abdomen in current study was 8%. There were two burst abdomen seen in conventional continuous closure technique and none in the interrupted figure of eight technique group. Conclusion: All the patients with generalized peritonitis in emergency setting need special attention regarding the wound closure. This newer technique of midline emergency laparotomy wound closure, especially in our part of the world significantly reduces the incidence of wound infection and wound dehiscence.