Prevention of Burst Abdomen By Interrupted Closure: A Comparative Study of Conventional Continuous Versus Interrupted-X-Type Versus Hughes Far-And-Near Interrupted Abdominal Fascial Closure in Surgical Patients
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 2
Abstract
Background: The occurrence of sudden disruption of the abdominal laparotomy wound is a major disaster in the life of a patient who has undergone an abdominal operation and a major psychological blow to the patient as well as the surgeon.Its prevention is important in reducing post-operative morbidity and mortality.The search for the optimal laparotomy technique has gone on for more than 100 years and will continue. Aims: The present study was undertaken to assess the incidence and relative risk of burst abdomen in post midline laparotomypatient using continuous suture versus interrupted X suture versusHughes Far-and-Near technique in sheath closure. Materials and Methods: This was a prospective randomised study. The data were collected at surgical wards of Rajindra Hospital, Government Medical College, Patiala. 90 patients undergoing emergency laparotomy through midline vertical incisions were randomized after informed consent by either continuous closure or by interrupted X or by Hughes Far-and-Neartechnique. The major outcome variable is risk of burst abdomen diagnosed by a consultant. The risk of burst in each group and relative risk (RR) of burst (using continuous group as the reference category) were assessed Main Outcome Variable: The risk of burst abdomen diagnosed by a consultant. Predictor Variables: wound infection, abdominal distension, cough, diabetes, anaemia, uraemia, malnutrition, old age, steroid intake, duration of surgery, duration of illness, smoking, alcohol, ileostomy, leakage of primary repair, early ambulation. Statistical Analysis: The risk of burst (incidence) in each group and relative risk (RR) of burst (using continuous group as the reference category) were calculated. Result: Ninety patients undergoing emergency laparotomy were randomized into three arms to undergo closure with continuous, interrupted-X, and Hughes Far-and-Near suturing techniques. Burst abdomen occurring up to 4 weeks of operation. Nineteen (21.1 %) of 90 patients developed burst in the post-operative period. 11(36.7 %) of 30 patients in continuous arm developed burst. Four of 30 (13.3 %) patients in Interrupted-X arm and 4 of 30 (13.3 %) patients in Hughes Far-and-Near arm developed burst. The relative risk for burst abdomen with continuous method as reference category and interrupted method as exposure category was 1.868 (p=0.011). Conclusion: Interrupted-X suture and Hughes Far-and-Near Interrupted Methods of suturing better than the Conventional Continuous methods in the management of closure of vertical laparotomy incision as the postoperative complications like wound dehiscence and wound infection were found to be significantly lesser with the use of interrupted method of closure. Wound infection (SSI), old age (>60 years), steroid intake, cough, duration of surgery, ileostomy, leakage of repair, and intake of alcohol are significant risk factors for burst abdomen.
Authors and Affiliations
Dr. Kuldip Singh Ahi, Dr. Sachin M. Khandekar, Dr. Sushil Kumar Mittal, Dr. Vikram Chaudhary, Dr. Ankur Sharma, Dr Aditya Jain, Dr Avnish Kumar
Keywords
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- EP ID EP592344
- DOI 10.9790/0853-1602072130.
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