DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173100

Comparison of continuous versus interrupted method of abdominal fascia closure using non - absorbable suture in the patients of acute peritonitis: our experience of 60 cases

Basudev Kumar, Abhinav Jauhari

Abstract


Background: The best method of wound closure would be one that provides adequate tensile strength to the incision until the wound heals and approximates the tissue in a way that normal healing mechanism can occur under optimal circumstance. The suture should remain secure even in the presence of local or systemic infection. The continuous suture has the advantage of an evenly distributed tension across the suture line and being more expedient. It also has the advantage of having a single suture line holding the fascia together. The interrupted suturing technique has the disadvantage of being time consuming.

Methods: All the patients of peritonitis were taken up for emergency laparotomy fulfilling the inclusion criteria will be included in the study. They were divided into two groups A and B by randomization technique. Each group contained 30 patients each. Patients included in group A underwent continuous method of abdominal fascia closure post laparotomy. Patients included in group B underwent interrupted method of abdominal fascia closure post laparotomy.

Results: In the present study, 60 cases of peritonitis were taken up, out of these mean age in the two groups were 34.03 years and 35.03 years respectively, majority of the patients were male 50 (83.3%); Most common diagnosis was of duodenal perforation peritonitis with 22 patient (36.7%), with Ileal perforation peritonitis 15 patients (25.0%), Kochs perforation peritonitis 13 patient (21.7%); Mean time taken for closure in continuous group was 13.10 minutes as compared to 16.00 minutes in interrupted group, This difference was statistically significant. Wound infection rate in two group were 26.7% and 33.3% respectively, wound infection was present in 30%of total patient. Burst abdomen was present in 20% in both the group.

Conclusions: Continuous suturing with polypropylene is comparable to interrupted suturing in terms of wound infection, frequency of burst abdomen. Although continuous suturing is better than interrupted suturing as it is faster, take less time in closure than interrupted closure. Continuous polypropylene thus becomes the preferred material and method of closure for abdominal fascia for acute peritonitis.


Keywords


Continuous suturing, Emergency laparotomy, Polypropylene

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References


Ellis H. Midline abdominal incision. Br J Obstet Gynecol. 1984;91:1-2.

Riou JPA, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg. 1992;163:324-30.

Ceydeli A, Rucinski J, Leslie wise. Finding the best abdominal closure: an evidence based review of the literature. Curr Surg. 2005;62(2):220-5.

Iwase K, Higaki J, Tanaka Y, Kondoh H, Yoshikawa M, Kamike W. Running closure of clean and contaminated abdominal wounds using a synthetic monofilament absorbable looped suture. Surg. Today. 1999;29:874-9.

McNeill PM, Sugerman HJ. Continuous absorbable versus interrupted non-absorbable fascial closure. Arch Surg. 1986;121:821-3.

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.

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.

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.

Sahlin S, Ahlberg J, Grantstrom L, Ljungstrom KG. Monofilament versus multifilament absorbable sutures for abdominal closure. Br J Surg. 1993;80:322-4.

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.

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.

Weiland Dl, CurtisBay R, DelSonli S. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176:666-70.

Jones TE, Newell ET, Brubaker RE. The use of alloy steel wire in the closure of abdominal wounds. Surg Gynecol Obstet. 1941;72:1056-9.

Burleson TE. Factors affecting wound healing. Wound healing for surgeons. London: BailliereTindall. 1984;42-75.

Choudhary SK, Choudhary SD. Mass closure versus larger closure of abdominal wound: a prospective clinical study. J Indian Med Assos. 1994:229-32.

Srivastava A, Roy S, Sahay KB, Vuthaluru S, Kumar A, Chumber S, 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(1):220-5.

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.