Layered Closure Versus Retention Closure Technique for the Abdominal Wall in Midline Laparotomy: A Longitudinal Cohort Study
Introduction: Midline laparotomy wound is closed in layers co-opting the various layers separately from historical times; however various methods of closure had come into vogue in the recent years. One such is the single layer mass closure technique, in which all the layers of the abdominal wall...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/15497/50007_190721_50007_CE[Ra1]_F[SK]_PF1(SC_SS)_PFA(AnK_SC)_PN(KM).pdf |
| Summary: | Introduction: Midline laparotomy wound is closed in layers
co-opting the various layers separately from historical times;
however various methods of closure had come into vogue in
the recent years. One such is the single layer mass closure
technique, in which all the layers of the abdominal wall are closed
in single layer, except for the skin and subcutaneous tissue. Yet
another method described is the retention closure technique
incorporating all layers including skin and subcutaneous tissue
are closed in a single layer.
Aim: To compare the postoperative wound complications
in layered closure with retention closure technique in midline
laparotomy.
Materials and Methods: This was a longitudinal cohort study
done on 57 consecutive patients who underwent midline
laparotomy on an elective or emergency basis over a 12 months
period from January 2014 to January 2015 in the Department
of General Surgery at Mahatma Gandhi Medical College and
Research Institute, Puducherry, India. They were divided in to two
groups depending on the closure type, layered closure (Group
A) and retention closure (Group B) depending on the operating
surgeon: retention closure was done in a single surgical unit and
layered closure was done in rest of the respective units. Patients
were followed up meticulously and immediate postoperative
complications were recorded up to four weeks. Statistical
analysis was carried out using SPSS version 19.0 (IBM SPSS,
US) software with regression modules installed. Chi-square test
and t-test were used to analyse the data.
Results: In Group A there was 30 patients while in Group B
there were 27 patients. In layered closure technique out 30
patients 12 (40%) patients developed wound infection, 1 (3.3%)
patient developed partial dehiscence, and 2 (6.6%) patients
developed complete dehiscence. In retention closure technique
out of 27 patients only 5 (18.5%) patients developed wound
infection, 3 (11%) patients developed partial dehiscence and
none of them had complete dehiscence in this group. There
was significant association between wound complications and
patients with uraemia and hypoalbuminemia. Out of 12 uremic
patients 8 (66%) developed wound infection (p-value=0.002), 2
(16.7%) patients developed partial dehiscence and 2 (16.7%)
patients developed complete dehiscence (p-value=0.06). In
patients who had hypoalbuminemia, out of seven patients, 5
(71.4%) patients had wound infection and 2 (28.6%) patients
did not have wound infection (p-value=0.01). Four (57.1%)
patients had partial dehiscence and 2 (28.6%) had complete
dehiscence only 1 (14.3%) patient did not have any dehiscence
(p-value=0.001).
Conclusion: Retention closure has some advantages over
layered closure in preventing wound infections and burst
abdomen. Various risk factors are associated with postoperative
wound complications, among which hypoalbuminemia and
uraemia have a strong association. |
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| ISSN: | 2249-782X 0973-709X |