A Comparative Study On Outcome Of Midline Laparotomy Wound Closure

ABSTRACT

Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. Factors as relates to burst abdomen and they recommended certain surgical measures. These measures included control of nausea and vomiting, decompression of distended abdomen, choice of appropriate sutures, control of infection and use abdominal drains. Wound dehiscence is related to the technique of closure of abdomen and the suture used. it is interned to study the closure of abdomen with non-absorbable (Polypropylene, Nylon) versus delayed-absorbable (Polydiaxanone)in cases operated at V.S. Hospital , Ahmedabad with respect to the effectiveness of these different suture materials in our setup.METHODS AND MATERIALSThepresent clinical Prospective comparative study was carried out at the surgery department of V.S. hospital from June2014 to Jan 2017. Patients underwent both elective and emergency laparotomy through midline vertical incisions. First 50 cases of midline laparotomy closure were studied with these three suture materials; Polydiaxanone (PDS), Nylon and Polypropylene (PPL) with/without retention suture. The patients were followed regularly after surgery up to 6 months.RESULT:Wound infection is the most important single factor in the development of burst abdomen and incisional hernia.61The incidence of wound infection was in Polypropylene (Prolene)(12.5%), in Polydiaxanone (PDS) (20%) and in Loop Nylon(12.5%) .The incidence of wound infection was related to type of surgery . As in over study infections were higher in emergency surgery then planned surgery, it was 10% in PDS group,12.5% in PPL group and 12.5% in loop nylon group. And in planned surgery only one case had wound infection, which was in nylon group. CONCLUSION:continuous suture technique using no.1 loop Polydiaxanone (PDS) had comparatively higher incidence of wound infection, and also report a case of burst abdomen, but had low incidence of scar pain for closure of midline laparotomyincision, No.1 Polypropylene had high incidence of stitch granuloma and Loop nylon no.1 had a low incidence of infection and stitch granuloma but high incidence of scar pain.. Burst abdomen had high incidence in high risk patient irrespective of suture material used, however this incidence can be reduced by prophylactic retention.