Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Main Article Content

Tariq Hayat Khan
Zeeshan Muhammad Jaffer
Rafi Ullah
Ali Hasnain Malik
Arif Hayat
Qaiser Hayat

Abstract

Background: Midline laparotomy is widely recognized as the preferred technique for abdominal surgeries due to its simplicity and the effective exposure it provides. Despite its prevalence, the optimal method for closing the incision remains a topic of debate among surgeons, particularly when balancing the risk of wound dehiscence with the practicalities of surgical practice. The mechanical properties of suture materials and techniques, such as continuous versus interrupted suturing, directly influence wound integrity during the critical postoperative period.


Objective: The aim of this study was to compare the effectiveness and complication rates of continuous versus interrupted suturing techniques in midline laparotomies, with a focus on the incidence of wound dehiscence.


Methods: This randomized controlled trial included 180 patients undergoing emergency laparotomy, divided into two groups: continuous closure (Group A) and interrupted closure (Group B). The study was conducted at Lady Reading Hospital MTI, Peshawar, with ethical committee approval. Participants were informed, consented, and demographic data were recorded. Suture techniques were performed by an experienced surgeon, and patients were monitored for wound dehiscence up to the 15th postoperative day. Data were analyzed using SPSS version 25.


Results: Group A reported a wound dehiscence rate of 14.4%, with an effectiveness rate of 85.6%. In comparison, Group B showed a significantly lower dehiscence rate of 5.6% and an effectiveness rate of 94.4%. The age-wise distribution of effectiveness indicated no statistically significant difference between the groups across various age ranges, with P-values ranging from 0.2766 to 0.6037. Gender-wise, males and females also did not show significant differences in effectiveness between the two groups.


Conclusion: Interrupted suturing for midline laparotomy closures showed a lower incidence of wound dehiscence compared to continuous suturing. However, factors such as increased surgery time and cost, along with postoperative issues like stitch sinus formation, need consideration. Further large-scale studies are recommended to evaluate the long-term outcomes and provide a more comprehensive assessment of the two techniques.

Article Details

How to Cite
Khan, T. H., Jaffer , Z. M., Ullah, R., Malik, A. H., Hayat, A., & Hayat, Q. (2024). Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence. Journal of Health and Rehabilitation Research, 4(1), 1102–1107. https://doi.org/10.61919/jhrr.v4i1.564
Section
Articles
Author Biographies

Tariq Hayat Khan, Lady Reading Hospital MTI Peshawar Pakistan.

Consultant General Laparoscopic and Trauma Surgeon, Assistant Professor, Lady Reading Hospital MTI Peshawar, Pakistan.

Zeeshan Muhammad Jaffer , Lady Reading Hospital Peshawar Pakistan.

Assistant Professor, Lady Reading Hospital Peshawar, Pakistan.

Rafi Ullah, Lady Reading Hospital Peshawar Pakistan.

Assistant Professor, Lady Reading Hospital Peshawar, Pakistan.

Ali Hasnain Malik, Lady Reading Hospital Peshawar Pakistan.

Consultant General Surgeon, Lady Reading Hospital Peshawar, Pakistan.

Arif Hayat, Hayat Abad Medical Complex Peshawar Pakistan.

Hayat Post Graduate Resident, Hayat Abad Medical Complex Peshawar, Pakistan.

Qaiser Hayat, CMH Peshawar Pakistan.

Post Graduate Resident, CMH Peshawar, Pakistan.

References

Aghara CB, Rajyaguru AM, Bhatt JG. Prospective comparative study of modified Smead Jones versus conventional continuous method of fascial closure in emergency midline laparotomy. International Surgery Journal. 2020;7(11):3713-7.

Alamdari NM, Shams F, Hajimirzaie SH, Besharat S, Fathi M, Farsi Y, et al. Comparing Simple Interrupted vs. Continuous Fascial Closure Methods in Elective Midline Laparotomy, a randomized controlled trial. 2023.

Albendary M, Mohamedahmed AYY, Alamin A, Rout S, George A, Zaman S. Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis. Langenbeck's Archives of Surgery. 2022;407(4):1333-44.

Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pakistan Journal of Medical Sciences. 2021;37(4):1118.

Badkur M, Ram S, Patel S, Gupta A. Comparison between continuous vs. interrupted x-suture for midline laparotomy wound closure. Gen Surg: Open Access. 2020;3(1):12-4.

Bala Brindha S. Comparison between Continuous Versus Modified Continuous Smead Jones Technique of Suturing in Closure of Rectus in Patients Undergoing Emergency Laparotomy in a Tertiary Care Centre: A Randomized Controlled Trial: Madras Medical College, Chennai; 2022.

Begum J, Ullah AF, Islam I, Chowdhury MAA, Al Mansur MA, Das UK. Comparison between Interrupted X Suture and Continuous Suture for Closure of Midline Incision in Emergency Laparotomy: A Randomized Controlled Trial. Chattagram Maa-O-Shishu Hospital Medical College Journal. 2022;21(2):52-6.

Bharti SV, Sharma A. A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure. Journal of Nepalgunj Medical College. 2020;18(1):63-6.

Chatterjee S, Bhattacharya T. A study to evaluate the effects of various abdominal closure techniques on midline laparotomy wounds in a tertiary care hospital in West Bengal. International Surgery Journal. 2021;8(4):1129-33.

Denys A, Monbailliu T, Allaeys M, Berrevoet F, van Ramshorst GH. Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia. 2021;25:449-62.

Garg A, Jayant S, Gupta AK, Bansal LK, Wani A, Chaudhary P. Comparison of closed incision negative pressure wound therapy with conventional dressing for reducing wound complications in emergency laparotomy. Polish Journal of Surgery. 2021;93(5):26-33.

Geehan G, Edelduok I, Bucholc M, Watson A, Bodnar Z, Johnston A, et al. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement: Special Issue: Trauma and Emergency: Beyond Damage Control Surgery. Life. 2021;11(2):1-14.

Hassan Y, Arajmand S, Wani A, Gilkar I, Shah S. Small bite closure in midline laparotomy; A practice to reduce the surgical site infection, wound dehiscence, and incisional hernia. Ibnosina Journal of Medicine and Biomedical Sciences. 2021;13(04):204-8.

Iswarya D. A Comparative study between Intermittent Smead Jones Rectus Closure and Continuous Rectus Closure in Midline Laparotomy Wound: Stanley Medical College, Chennai; 2021.

Joshi D, Varandani N, Vaidya M. Study of different methods of midline laparotomy incision closure and their outcomes. MVP Journal of Medical Sciences. 2021:249–52-–52.

Kumar M, Sathyaraj P, Ramprasath S, Renganathan M. Comparative study between mass closure suturing technique and Hughes repair in emergency midline laparotomies. Asian Journal of Medical Sciences. 2023;14(10):235-9.

Mc Geehan G, Edelduok IM, Bucholc M, Watson A, Bodnar Z, Johnston A, et al. Systematic review and meta-analysis of wound bundles in emergency midline laparotomy identifies that it is time for improvement. Life. 2021;11(2):138.

Metawee AK, Abdelhamid HF, Aldardeer AK. Comparison between conventional and modified Smead Jones method for abdominal mass closure in emergency midline laparotomy. 2020.

Polychronidis G, Rahbari NN, Bruckner T, Sander A, Sommer F, Usta S, et al. Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: a randomized controlled trial [NCT00544583]. World Journal of Emergency Surgery. 2023;18(1):51.

Rafiq MK, Kamran H, Sultan B, Khan YA, Wadud F, Ayub M, et al. Outcome Of The Choice Of Wound Closure Technique In Emergency Laparotomy. Journal of Ayub Medical College Abbottabad-Pakistan. 2022;34(1).

Roy S, Kundu K, Das S, Kuiri SS. Comparative study between continuous and interrupted suturing for rectus sheath closure in exploratory laparotomy. Asian Journal of Medical Sciences. 2022;13(5).

Sahu S, Kumar R, Kumar A, Soni S, Pandey S, Kapur N, et al. Comparison of laparotomy wound closure for vertical midline incision with farnear technique using nylon and interrupted-X technique using polyglactin 910: a prospective study. Surgical Chronicles. 2021;26(2).

Sehgal M, Thakur N. A Cross Sectional Study to Evaluate the Impact of Suturing Technique on Wound Dehiscence in Midline Laparotomy in A Tertiary Care Hospital. Himalayan Journal of Applied Medical Sciences and Research. 2021;2(5).

Sharma G, Prashar N, Gandotra N. Comparison of suture technique (interrupted vs. continuous) with respect to wound dehiscence. Indian Journal of Medical Sciences. 2020;72(3):191-4.

Murtaza B, Saeed S, Sharif MA. Postoperative complications in emergency versus elective laparotomies at a peripheral hospital. Journal of Ayub Medical College Abbottabad. 2010;22(3):42-7.

Ullah K, Uddin S, Shoib A, Yaseen MD. Comparison of outcome of interrupted versus continuous closure technique of rectus sheath in emergency laparotomies patients in terms of wound dehiscence. The Professional Medical Journal. 2021;28(04):455-8.

Venkateswaran R, Bhagvat S, Dutt A, Padekar HD, Mirkhushal N, Chetan AA, et al. Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study. Cureus. 2023;15(11).

Wolf S, de Gracia LA, Sommer F, Schrempf MC, Anthuber M, Vlasenko D. Continuous and interrupted abdominal-wall closure after primary emergency midline laparotomy (CONIAC-trial): study protocol for a randomised controlled single centre trial. BMJ open. 2022;12(11):e059709.

Nitin K, Vasudevaiah T, Nayak D, Naik D, Dilip D. Comparative study of efficacy of modified Smead-Jones technique versus conventional closure of midline laparotomy wound. Int J Surg Sci. 2020;4(1):134-7.

Yii E, Onggo J, Yii MK. Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis. Asian Journal of Surgery. 2023.