Details
Category: Volume 07 Issue 10 October 2019
Hits: 1362

Title: A comparative study of the outcome of Mass Closure and Layered closure techniques for Midline Abdominal Incisions in a Teaching Hospital

Authors: Dr CH. Maruthi, Dr Arun Katari

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.44

Abstract

  

The abdomen is the frequent site of operations in General Surgery, consequently incision and suturing of the abdominal wall is a very important aspect of surgery. Conventionally the midline incision of laparotomy wound is closed in various layers anatomically. However, a newer method called the Mass closure technique is increasingly being utilized for its advantages. We in the present study tried to evaluate the outcomes of midline abdominal surgeries using mass closures and layered closure techniques. Methods: This prospective study was carried out in the Department of General Surgery, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar. A total of 55 patients were identified during the study period and they were divided into two groups. Group I patients who were sutured with Mass closure technique and Group II patients who had their midline incision closed with conventional layered technique. Results: The most common complication in the group I was found to be a superficial infection in n=2(8%) of patients. The other complications were seroma, burst abdomen (wound dehiscence), suture sinus formation in n=1 (4%) cases each. In group II layered closure wound infection was found in n=2 cases, both were superficial infections which were managed adequately. Burst abdomen and seroma were also found in n=2(6.67%), hematoma, and the incisional hernia was seen in n=1 (3.33%) cases each. Conclusion: Within the limitations of the present study it can be concluded that the mass closure technique appears to be the better choice for midline laparotomy wound closure as compared to the conventional layered technique since it requires a shorter time, with minimal complications and cost-effective.

Keywords: midline abdominal incisions, Mass closure, Layered closure.

References

  1. Murtaza B, Khan NA, Sharif MA. Modified midline abdominal wound closure technique in complicated/high-risk laparotomies. J Coll Phys Surg Pak. 2010;20(1):37-41.
  2. Malik AR, Scott NA. Double near and far prolene suture closure: a technique for abdominal wall closure after laparotomy. Br J Surg. 2001;88(1):146-47.
  3. Ceydeli A, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg. 2005;62:220-25.
  4. Tocchi A, Liotta G, Mazzoni G, Lepre L, Costa G, Agostini N, et al. Closure of laparotomy wounds. G Chir 2000;21:463-68.
  5. Sutton G. and Morgan S. Abdominal wound closure using a running, looped Monofilament polyester suture: Comparison to Smead-Jones Closure in Historic Controls. Obstet Gynecol 1992; 80(4):650-54.
  6. Sivam N.S., Suresh S., Hadke M.S., Kate V., Ananthakrishnan N. Results of the Smead-Jones technique of closure of vertical midline incisions for emergency laparotomies a prospective study of 403 patients. Trop Gastroenterol, 1995;16 (4): 62-67.
  7. Seid MH. A randomized trial of abdominal suture technique and wound strength. Arch Surg 1995;130:194-97.
  8. Principals of abdominal wall closure. Available at 19.3: Sept 2011 https:// cursoenarm.net/ Up To Date. Accessed on 28 August 2019.
  9. Jenkins TPN. The burst abdomen wound: a mechanical approach. Br J Surg. 1976; 63:873-76.
  10. Israelsson LA, Jinsson T. Suture length to wound length ratio in healing laparotomy incisions. Br J Surg. 1993;80:1284-46.
  11. Gupta H, Srivastava A, Menon GR, Agrawal CS, Chumber S, Kumar S. Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials. Asian J Surg. 2008;31:104-14.
  12. Robert E. Roses, Jon B. Morris. Incisions, closures, and management of an abdominal wound. Maingot's Abdominal Operations. 12th Edition. The McGrawHill Companies Inc. 2012;99-20.
  13. Chowdhury S.K., Choudhury S.D. Mass Closure versus layer Closure of Abdominal Wound: A Prospective Clinical Study. J Ind. Med Assoc. 1994; 92 (7):229-32.
  14. Dudley HA. Layered and mass closure of the abdominal wall. Br J Surg 1970;57:664-67.
  15. Krukowski ZB, Cusick EL, Engeset J, Matheson JA. Polydioxanone or polypropylene for the closure of midline abdominal incisions: a prospective comparative clinical trial. Br J Surg. 1987;74:828–830.
  16. Wissing J, van Vroonhoven TJ, Schattenkerk ME, Veen HF, Ponsen RJ, Jeekel J. Fascia closure after midline laparotomy: results of a randomized trial. Br J Surg. 1987;74;738–41.
  17. Deshmukh SN, Maske AN. Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study. Int Surg J 2018;5:584-87.
  18. Bhavikatti GS, Gupta GHVR. Comparative Study of Mass Closure and Layered Closure Techniques in Midline and Paramedian Laparotomies. Acad. J Surg. 2019;2(1):42-46.
  19. Banerjee P, Chatterjee A. Critical evaluation of conventional abdominal closure with single-layer closure in adult and elderly. J Indian Med Assoc 1989;87:277-78.

Corresponding Author

Dr Arun Katari

Associate Professor, Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar , 505001 Telangana State, India