A STUDY TO COMPARE THE EFFICACY OF THREE SUTURING TECHNIQUES IN REDUCING THE DEVELOPMENT OF POST-OPERATIVE COMPLICATIONS AMONG PATIENTS WITH GENERALIZED PERITONITIS WHO UNDERWENT EMERGENCY MIDLINE LAPAROTOMY WHILE ADMITTED IN THE GENERAL SURGICAL UNITS OF

Abstract

Background: This study seeks to allocate patients into two groups: one, in which the continuous technique is used for the closure of the linea alba, and the other in which an interrupted technique is used. The study aspires to observe and record wound complications after midline laparotomy incisions in the hope of spurring renewed interest in abdominal closure, and possibly gathering evidence that warrants change in the current trend, or evidence encouraging the ongoing practice.

Methods: A descriptive design was used to conduct the study. The purpose of the design was to compare and document the post-operative complications arising with the use of three suturing techniques. The suture technique was based on the discretion of the operating surgeon. It was a prospective randomized study where all consecutive subjects who fulfilled the inclusion criteria were incorporated. The study comprised of 100 subjects.

Results: There was a male predominance in the subject profile. Males comprised 79% of the study population. Peptic perforation was the most common cause of generalized peritonitis in the population under study. Patients with interrupted closure had a lower incidence of wound infection, wound dehiscence, burst abdomen, and incision hernia as compared to those closed by the continuous technique. The difference was not statistically significant. Jaundice, renal failure, enteric fever, and presence of stoma were associated with an increased risk of wound disruption. Pulmonary disease was associated with increased post-operative wound dehiscence, burst abdomen, and development of incisional hernia. Admission to the surgical intensive care unit and mechanical ventilation are associated with an increased risk of development of post-operative wound disruption and subsequent incisional hernia. As it was found that 40% of subjects who developed incisional hernia had a preceding wound infection, the incidence of incisional hernia would be reduced by the elimination of wound sepsis.

Conclusion: This study shows that the interrupted technique ((prof. hughes> Interrupted Double-X) of fascial closure is superior to the continuous technique in prevention of both early and late wound complications in a contaminated wound. Further larger studies are indicated to demonstrate statistical significance. Various modifiable risk factors have been described to decrease the rate of development of post- operative wound complications.

Keywords: Operative, Patients, Laparotomy