A Prospective study Comparing the Efficacy of Mass Closure and Layer by Layer Closure of Midline Laparotomy and Its Influence on Wound Healing

Sanjeev Kumar, S (2012) A Prospective study Comparing the Efficacy of Mass Closure and Layer by Layer Closure of Midline Laparotomy and Its Influence on Wound Healing. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION: In abdominal surgery, properly chosen incision, correct method of making incision and closure of such wounds are factors which play an important role. The ideal method of abdominal wound closure should be technically simple and it should be free from postoperative wound complications of wound infection, wound dehiscence, incisional hernia, suture sinus formation and should leave a reasonably aesthetic scar. The present study is a prospective comparative study between single layered closure versus conventional layered closure of ventral abdominal wounds with midline incisions. This study was done mainly to compare the two methods of midline laparotomy closure i.e. mass and layered closure taking into regard wound complications { wound infection, wound dehiscence (burst abdomen) }, incisional hernia , time taken for closure and wound strength. The study was carried on 50 patients who underwent both elective and emergency laparotomies through midline incisions. Equal number of cases (25 each) were studied for closure with the two techniques, namely mass closure and layered closure. METHODS: In the layered closure technique, the abdominal wall was closed layer by layer, with an anatomical approximation from deep to superficial layers. Peritoneum was first closed with 1-0 chromic catgut continuous sutures. Next the linea alba was closed with 1 polypropelene continuous interlocking sutures. Subcutaneous tissue closed interruptedly with 1-0 plain catgut. Skin closed interruptedly with no 1 silk or skin stapler. In mass closure technique, the suture material used was 1 polypropelene. Suturing was done with continuous sutures. All layers of the abdominal wall except skin were included in single layer. Large bites were taken about 1 cm from the wound edge with a distance of 1 cm between the sutures (Jenkin’s technique). Skin closed with no 1 silk. OBSERVATION AND RESULTS: The main observations from the study were as follows: 1. Mass closure has less incidence of postoperative wound infection than the layered closure. (p value 0.012 i.e < 0.5, hence significant). 2. Mass closure has apparently less incidence of postoperative wound dehiscence than its counterpart although not statistically significant (p value 0.48 i.e > 0.5, not significant). 3. Mass closure appears to have less incidence of incisional hernia when compared to layered closure but this is not statistically significant. (p value 1.0000 i.e. greater than 0.5 , hence not significant). 4. The time consumption is less for mass closure of the midline laparotomies than those required for layered closure. 5. Mass closure has got better patient compliance than the layered closure. CONCLUSION: The main conclusion that we gather from the study is that the mass closure of the midline laparotomy is a better option than layered closure in providing strength to the wound and in preventing the occurrence of infection and wound disruption.

Item Type: Thesis (Masters)
Additional Information: Reg.No.22091221
Uncontrolled Keywords: Mass closure, layered closure, wound dehiscence, incisional hernia.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 14 Sep 2020 18:01
Last Modified: 15 Sep 2020 15:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/13148

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