Comparison of continuous versus interrupted abdominal fascia closure in patients of perforation peritonitis using Polydioxanone (PDS) suture: A prospective study of 50 cases
Author Name : Dr. Rajender Kumar Karwasara, Dr. Satish Dalal, Dr. Vipul Bakshi
OBJECTIVE: Comparison of closure of midline laparotomy fascia using interrupted PDS v/s continuous PDS in emergency settings in terms of wound infection, wound dehiscence, incisional hernia and suture sinus.
METHODS: The present prospective study was conducted in Department of General Surgery, Pt. B. D. Sharma Institute of Medical Sciences, Rohtak. A total of 50 patients were enrolled who were operated in emergency operation theatre. These patients were grouped in two groups of 25 each. Alternate patient was allocated to Group I and Group II. Group I (study group) patients underwent interrupted closure of abdominal wall using polydioxanone No 1 suture. Group II (control group) underwent continuous closure of abdominal wall using polydioxanone No 1 suture.
RESULTS: The mean age in Group I was 39.16 and 41.4 in Group II. Majority of the patients were male (88%). Mean length of incision in both the groups were comparable i.e. 20.64 in group I and 20.56 in group II. The mean time taken for closure of rectus sheath in Group I was 39.56 mins and 19.8 mins in Group II. Mean duration of hospital stay in Group I was 12.84 days and 12.2 days in Group II. Also, 6 patients (28%) in Group I underwent wound infection as compared to 4 patients (16%) in Group II. Two patients (8%) belonged to Group I both of which had localised fascial burst and 1 patient (4%) was from Group II who had complete fascial burst. All 3 patients of fascial wound dehiscence were patients of peptic perforation. Further management of this complication in interrupted group only required regular aseptic dressing and secondary suturing while continuous group patient had to undergo a Bagota Bag application under general anaesthesia. One case (4%) of incisional hernia was observed in both the groups at the 3rd month of follow up. Three (12%) patients in interrupted group and one (4%) in continuous developed suture sinus.
CONCLUSION: In a patient with peritonitis, midline abdominal fascial closure should preferably be done with interrupted PDS as wound dehiscence is localised and easier to manage.