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Category: Volume 07 Issue 02 February 2019
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Title: Comparison of Suture Technique (Interrupted vs Continuous) with respect to Wound Dehiscence

Authors; Nitin Kumar Jhalani, Bhupen Songra, Richa Jain, Mohit Jain, Rajeev Lochan Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.07

Abstract

Background: Wound dehiscence/burst abdomen is a very serious postoperative complication associated with high morbidity and mortality. It has a significant impact on health care cost both for the patient and the hospital. Abdominal wound dehiscence is the major cause of morbidity following any laparotomy whether elective or emergency. The aim of the study was to compare wound dehiscence between the patients underwent two different suture technique of rectus sheath closure.

Material and Methods: In our study total 480 subjects with perforation peritonitis who were operated through midline incision were included. They were divided into 2 groups 240 subject in each group:1) Test (interrupted suture) and2) Control group (continuous suture) group. In test group the abdominal closure was done by interrupted suture technique while in control group abdominal closure was done by continuous suture technique. Patients were followed up and wound dehiscence/burst abdomen was assessed at day 3, 7 and 1 month postoperatively.

Results: The mean age in group 1 was 49.60 years while in group 2 was 49.02 years. In both the groups male sex was predominant (78.3% and 75.8%). Most common diagnosis was peptic perforation followed by illeal perforation in both the groups. Incidence of wound dehiscence was significantly less in group 1 (7.9%) compared to group 2 (19.5%) and most of wound dehiscence occurred at 7th day postoperatively in both the groups.

Conclusions: The conclusion of our study is that rectus sheath closure by interrupted suture is better than continuous suture in terms of wound dehiscence.

References

  1. Ellis H. Midline abdominal incision. Br J Obstet Gynecol. 1984;91:1-2.
  2. Waqar sh, Malk ZI Razzaq A, Abdullah Mt shaima A .Zahid Ma.Frequency and risk factors for wound dehiscence/ abdominal burst inmidline laparotomies. Journal Ayub med coll 2005,17:70-73.
  3. Begum B, Zaman R, Ahmed M, Ali S. Burst abdomen: a preventablemorbidity Mymen Singh med J 2008;17:63-6.
  4. Emad esmat. A new technique in closure of burst abdomen TI, TIEand TIES incisions world J Surg. 2006; 20:1063-73.
  5. Fleisher GM, Rennert A, RA 1/4 hmer M. infected abdominal wall andburst abdomen Chirurg. 2000; 71:754-62.
  6. Shukla HS, Kumar S, Misra MC, Naithani YP. Burst abdomen andsuture material: A comparison of abdominal wound closure withmonofilament nylon and chromic catgut. Indian J Surg. 1981;43:487-91.
  7. Singh A, Singh S, Dhaliwal US, Singh S .Technique of abdominalwound closure: a comparative study. Ind J Surg 1981;43:785-90
  8. Choudhary SK, Choudhary SD, Mass closure versus layer closure ofabdominal wound: A prospective clinical study. J Indian Med assoc.1994;92:229-32
  9. Efron, G: Abdominal wound disruption. Lancet 19:1287, 1965.
  10. Guiney, E. J, Morris<P.J and Donaldson, G.A: Wound dehiscence Acontinuing problem in abdominal surgery. Arch. Surg, 92:47,1996.
  11. Madden, J.L: Atlas of techniques in surgery. Volume 1. Secondedition. New york, Appleton-Century-Croft 1964.
  12. Altemeier, W. A: Hospital acquired infections in surgery and their significance. North west med 65:589, 1964.
  13. Halasz, N .A: Dehiscence of laparotomy wounds AM.J. Surg, 116:210, 1968.
  14. Raahave, D: Aseptic barriers of plastic to prevent bacterial contaminationof operation wounds. Acta Chur. Scand, 140:603,1974.
  15. Hunt, T K: Wound Complications. In Hardy, J. D. (ed.) Managementof surgical complications, Philadelphia, W.B Saunders Company, 1975.
  16. Mayo, Ch .W. and Lee, M.J: Separations of abdominal wounds. A.M.AArch. Surg. 62:883, 1951.
  17. Chandra Shekhar Agrawal Pamit Tiwari Sangeeta Mishra Arpit Rao Niladhar S. Hadke Shailesh Adhikari & Anurag Srivastava et al: Interrupted Abdominal Closure Prevents Burst: Randomized Controlled Trial Comparing Interrupted-X and Conventional Continuous Closures in Surgical and Gynecological Patients. Indian J Surg DOI 1007/s12262-012-0611-8. Received: 25 November 2010 / Accepted: 6 June 2012.
  18. Niggebrugge AH, Hansen BE, Trimbos JB, Van de Velde CJ,Zwaveling A, Mechanical factors influencing the incidence of burstabdomen. Eur J Surg 1995;161:655-61.
  19. Wound dehiscence: is still a problem in 21th century: A retrospective study. John spilitios, Konstantinos Tsiveriotis, Anastasios D Datsis, Arcodoula Vaxevanidou, Georgios Zacharis, Konstantinos Giafis, Spyros Kekelos and athanasiosRogdakis. World journal of emergency surgery 2009,4:12 doi10.1186/1749-7922-4-12.
  20. Irvin TT. Wound r repair .Closure of the abdominal wound. Ann R collSurgEngl 1978;60:224-6.
  21. Ellis H, Bucknall TE, Cox PJ. Abdominal incisions and their closure. Curr prob surg 1985;22:1-51.
  22. Ausobsky Jr, Evans M, Pollock AV. Does mass closure of midline laparotomies stand the test of the time? A random control of clinical trial. Ann R collSurgEngl 1985;67:159-61.
  23. Singh A, Singh S, Dhaliwal US, Singh S .Technique of abdominal wound closure: a comparative study. Ind J Surg 1981;43:785-90.
  24. Trimbos JB, Smit IB, Holm JP, Hermans J.A randomized clinical trial comparing two methods of fascia closure following midline laparotomy. Arch Surg 1992;127:1232-4.
  25. Mc Neill PM, Surgerman HJ. Continuous absorbable vs interrupted non absorbable fascial closure.A prospective, randomized comparison. Arch surg 1986;121:821-3.
  26. Colombo M, Maggioni A, Pama G, Scalambrino S, Milani, A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecological cancer. ObstetGyneco. 1997;89:684-9.
  27. Brolin RE. Prospective randomized evaluation of midline fascial closure in gastric bariatric operations AM J Surg. 1996;172:28-331
  28. Niggebrugge AH, Hansen BE, Trimbos JB, Van de Velde CJ, Zwaveling A, Mechanical factors influencing the incidence of burst abdomen. Eur J Surg. 1995;161:655-61.
  29. Anurag Srivastava, Swapandeep Roy, K. B. Sahay, Vuthaluru Seenu, Arvind Kumar, Sunil Chumber, Sabyasachi Bal, Sadanand Mehta et al Prevention of burst abdominal wound by a new technique: A randomized trial comparing continuous versus interrupted X- suture. Indian J Surg 2004;66:19-27.
  30. Trimbos JB, Smit IB, Holm JP, Hermans J.A randomized clinical trialcomparing two methods of fascia closure following midline laparotomy.Arch Surg 1992;127:1232-4.
  31. Grantcharov TP, Rosenberg J. Vertical compared with transverseincisions in abdominal surgery. Eur J Surg 2001;167:260-7.
  32. Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of abdominalmidline fascia. Metaanalysisdelieneates the optimal technique Am JSurg 2001;67:421-6.
  33. Shukla RN. Surgical Wound Infection and Suture Material - A Study of 60 Cases. Indian Journal of Applied Research 2015;5:63-9.
  34. McNeill PM, Sugerman HJ. Continuous absorbable vs interrupted non absorbable fascial closure. A prospective,randomized comparison. Arch Surg 1986;121:821-3.
  35. Richards PC, Balch CM, Aldrete JS. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous versus interrupted suture techniques. Ann Surg 1983;197:238-43.
  36. Gislason H, Gronbech JE, Soreide O. Burst abdomen and incisional hernia after major gastrointestinal operations - comparison of three closure techniques. Eur J Surg. 1995;161:349-54.
  37. Cruse PJE, Foord R. The epidemiology of wound infection. A ten year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27-40.
  38. Stone HH, Hoefling SJ, Strom PR, Dunlop WE, Fabian TC. Abdominal incisions: transverse vs. vertical placement and continuous versus interrupted closure. South Med J. 1983;76:1106-8.
  39. Sahlin S, Ahlberg J, Grantstrom L, Ljungstrom KG. Monofilament versus multifilament absorbable sutures for abdominal closure. Br J Surg. 1993;80:322-4.
  40. Van’t Riet M, Steyerberg EW, Netlensteyn J, Bonjer HJ, for JeeKel J. Metaanalysis of techniques closure of midline abdominal incisions. Br J Surg. 2002;89:1350-6.
  41. Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg. 2001;67(5):421-6.
  42. Weiland Dl, CurtisBay R, DelSonli S. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176:666-70.
  43. Richards PC, Balch CM, Adrete JS. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous versus interrupted suture techniques. Ann Surg. 1983:197:238-43.

Corresponding Author

Bhupen Songara

Professor, Department of General Surgery, S.M.S. Medical College, Jaipur, India

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