MANAGEMENT AND OUTCOME OF ABDOMINAL WALL CLOSURE IN EMERGENCY LAPAROTOMY AT A TERTIARY CARE CENTRE

Abstract

Objective: Abdominal wall closure of an emergency laparotomy involves a great deal of consideration. An ideal laparotomy wound closure should be efficient. provide strength and serve as a barrier to infection. The aim of this study is to compare and evaluate the advantages of layered closure in comparison with the mass layered closure, the types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia.

Methods: This prospective study was carried out over a period of 18 months enrolling a total of 90 patients split into two groups with group 1 undergoing mass closure using both interrupted and continuous methods and group 2 undergoing layered closure using both interrupted and continuous methods of suturing.

Results: A higher rate of wound complications was noted in the layered closure group (37.7%) than the mass closure group (17%). Wound complications were also noted to be higher in closures done with prolene suture (37.7%) than PDS (20%). As far as techniques were concerned, interrupted and continuous suturing had a similar rate of complications. Of all the comorbidities, considered in the study, the highest rate of wound related complications were seen in patients with pulmonary complications (13.3%).

Conclusion: Although the ideal way to close an abdomen post laparotomy has not yet been discovered, our study shows that mass closure with PDS suture to close the abdominal wall should be advocated as there is decreased early and late post operative wound complications

Keywords: PDS.