Prospective Study of Two Management Strategies for Dirty Abdominal Incisions following Laparotomy for Ruptured Appendicitis
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 2
Abstract
Background: The rate of surgical site infection (SSI) for dirty abdominal wounds is about 40%. The optimal closure method, for dirty abdominal incisions, that will reduce SSI still remains controversial. The aim of this study is to determine the optimal method of wound closure, after laparotomy, for patients with ruptured appendicitis. Methods: Eighty-seven patients were randomized into one of the primary closure (PC) group and delayed primary closure (DPC) group. Patients in the PC group had their surgical incisions closed immediately while for those in the latter group had DPC. Incisions in the DPC group were evaluated on postoperative day-4 (POD4), for closure if pristine. However, if SSI was suspected in both groups, the dressing was removed for wound inspection using sterile technique (also in the PC group, sutures were removed over the infected area to allow egress of exudates), and wound dressing was commenced. The main outcome measures were the incidence of surgical site infection and the length of hospital stay. Results: In the entire series, SSI developed in 40.2 % of patients after closure of incisions. Primary closure group had a higher incidence of SSI (41.9% vs 38.6%, p = 0.088) and longer LOS (8.1 + 3.7 days vs 7.3 + 2.2 days, p= 0.12). Conclusion: There was no significant difference in the development of SSI between the two groups (P >0.05). Laparotomy incisions, after ruptured appendicitis, most often can be closed primarily without a significant increase in the incidence of SSI as compared to DPC
Authors and Affiliations
IDRIS Oluwatoyin Jelilat
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