Prevention of the Abdominal Wound Related Complications with Using Interrupted Whole Layer Closure in Peritonitis Patients

ABSTRACT

PURPOSE: We report here on our experience with interrupted whole layer closure of abdominal wounds with using 1-0 polyester (Green Polyester(R), Ailee, Busan, Korea) during emergency operations for peritonitis patients. METHODS: We studied 163 patients who had emergency laparotomy performed at Soonchunhyang University Hospital, the Department of Surgery from March, 2005 to February, 2008. The abdominal wall was closed by layered suture in 126 patients (the LL group), and by interrupted whole layer suture in 37 patients (the WL group). Based on the medical records, we retrospectively analyzed and compared the clinical factors and wound-related complication between the two groups. RESULTS: Although there were no differences in age, gender, the course of admission and the chief complaint between the two groups, the WL group had a significantly greater number of patients with a deteriorated mental state, a history of shock and abnormality that was seen on chest X-ray. The average operation time was 116 minutes for the WL group and 158 minutes for the LL group, and the most common cause of peritonitis was bowel perforation in both groups (WL group 43%, LL group 60%) and this was followed by bowel obstruction (WL group 19%, LL group 18%). There were no differences in the total incidence of complications and the mortality between the two groups, but the incidence of wound-related complication was higher in the LL group (WL group 5%, LL group 31%). The average follow-up period was 308 days in the WL group and 222 days in the LL group. There were 2 cases of delayed wound hernia in the WL group and 6 cases in the LL group. CONCLUSION: Interrupted whole layer closure during performance of emergency laparotomy for peritonitis patient is very effective for preventing postoperative wound-related complication and it is as effective as layered suture for preventing delayed ventral hernia in the long-term.