Original Research Article
Year: 2019 | Month: August | Volume: 6 | Issue: 8 | Pages: 25-30
Comparison of Continuous Vs. Interrupted Method of Abdominal Fascial Closure in Patients with Septic Peritonitis in Gynecological and Urological Cases – A Randomized Retrospective Trial of 120 Cases
Supriya Chaubey1, Umesh Sharma2
1Department of Obstetrics & Gynecology, GTB Hospital, New Delhi, India 110095.
2Department of Urology & Renal Transplant, RML hospital, New Delhi, India, 110092.
Corresponding Author: Umesh Sharma
ABSTRACT
Background: Various randomized studies have evaluated techniques of abdominal fascia closure in elective laparotomies with few studies in emergency laparotomies, but controversy remains, leaving surgeons uncertain about the optimal method of preventing wound dehiscence in peritonitis.
Methods and material: Continuous and interrupted mass closures were compared randomly in 120 patients of septic peritonitis due to gynecological and urological emergencies. Patients were divided into three groups. Group 1 having uterine perforations, Group 2 had post radical cystectomy bowel leak and Group 3 had intraperitoneal bladder perforation following endourological procedures. Each group is further divided into Group c who underwent continuous non-locking closure and Group i with interrupted suture in figure of eight manner. Both methods of closure were performed with non-absorbable polypropylene no.1 suture.
Results: Out of 120 patients, Group 1 constitutes 68 patients (Group 1c =26%, Group 1i =30%), Group 2 had 36 patients (Group 2c =14%, group 2i =16%) and Group 3 had 16 patients (Group 3c =9%, Group 3i =5%). Twenty (33.33%) subjects with continuous closure and eighteen (30%) with interrupted closure had wound infection (p=0.78). Eighteen (30%) patients with continuous closure who had wound infection suffered from wound dehiscence (without evisceration) while four (6.66%) patients with interrupted closure had partial wound dehiscence. The follow up period was 13 months. All the patients with wound dehiscence in continuous closure group ultimately developed incisional hernia with none cases reported in interrupted group. The mean SL: WL ratio was 4.20 in continuous closure and 6.85 in interrupted closure (p=0.000). The continuous suturing was faster than interrupted suturing (p=0.000).
Conclusion: Interrupted emergency laparotomy wound closure reduces the rate of wound dehiscence as compared with continuous wound closure in peritonitis.
Key words: abdominal fascial closure, continuous, interrupted, non-absorbable suture.
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