Comparative Study of Wound Complications following Laparotomy for Typhoid Intestinal Perforation: Primary versus Delayed Primary Closure? A Prospective Randomized trial.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 11
Abstract
Background The optimal closure method, for dirty abdominal incisions, that will reduce wound complications remains controversial. The aim of this study is to compare wound complications after primary closure and delayed primary closure of laparotomy incisions following typhoid intestinal perforation (TIP). Methods: One hundred and twelve patients with dirty abdominal wounds following laparotomy for TIP were included. They were randomized into one of the two methods of wound management viz: primary closure (PC) group and delayed primary closure (DPC) group. Patients in the PC group have their surgical incisions (skin and subcutaneous layers) closed immediately while in the DPC group, the incisions were left open (packed with saline soaked gauze) and were evaluated on postoperative day 4 for closure if pristine or for wound dressing if not appropriate for closure. Wounds were considered infected if serous or purulent discharge developed and this would necessitate taking a wound swab for microscopy, culture and sensitivity (MCS). All patients were followed up for one month after surgery. The main outcome measures were the rates of surgical site infection, wound dehiscence and the length of hospital stay (LOS). Results: In the entire series, surgical site infection developed in 55.4 % of patients after closure of incisions. The primary closure group had a significantly higher incidence of SSI (73.2% vs. 37.5%, p = 0.000). There were also significantly more cases of wound dehiscence in the PC group (14.3% vs. 3.6%, p = 0.020) and significantly longer LOS (12.6 + 5.7 (SD) days vs. 10.1 + 3.7 (SD) days, p= 0.006). The overall short-term cosmetic results for DPC scars were also superior to those for PC (p = 0.425). Conclusion: Delayed primary closure is the optimal incision management technique that should be utilized for laparotomy incisions following TIP. It significantly lowers the rate of superficial surgical site infection and wound dehiscence, as well as reducing the mean LOS. There was no significant difference in the short-term cosmetic appearance of the scars between the two groups.
Authors and Affiliations
Idris Olawale Lateef, Idris Oluwatoyin Jelilat, Kolawole Oladapo Adedayo, Adejumobi Musibau Olaniyi, Adegoke Abiodun Adebimpe, Oseni Oyediran Ganiyu, Agbakwuru Elugwaraonu Augustine
Keywords
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- EP ID EP409172
- DOI 10.9790/0853-1711026166.
- Views 72
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