Vivek, Samuel Gaikwad (2008) A Study to compare the efficacy of two suturing techniques in reducing the development of post-operative complications among patients with generalized peritonitis who underwent Midline Laparotomy. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: The abdominal cavity has rightly been compared to Pandora’s Box. Innumerable processes are simultaneously at work to maintain a physiological milieu compatible with life. Various extrinsic and intrinsic insults can lead to disease and affect normal functioning of abdominal organs. Many abdominal disease processes demand surgical correction in the form of a laparotomy. Even today, diagnostic surgical exploration is sometimes necessary. Vertical midline incisions have long been popular. This is because of the ease and expediency with which they can be made and closed. A midline approach provides access to all quadrants of the abdomen. It avoids devascularisation and denervation during incision or closure. The incision can be extended easily when necessary. The chief disadvantage of the midline incision is the common occurrence of wound disruption and incisional hernia. Moynihan in 1926 stated, “I do not think that, though much has been written thereon, it is yet adequately recognized that the steps in the making and in the repair of an abdominal wound are of the greatest importance.” More than three-quarters of a century later, abdominal wound closure still remains a controversial subject, among even the most renowned surgeons. The present day incidence of wound dehiscence ranges from 1 to 6 percent while burst abdomen remains at 1-3 percent. The mortality associated with disruption may be as high as 35 to 40 percent. OBJECTIVES OF THE STUDY: The purpose of the study includes the following: 1. To assess the incidence of post-operative complications among patients with generalized peritonitis undergoing midline laparotomy. 2. To determine the association between the suturing techniques and postoperative complications and to see if interrupted closure led to fewer postoperative complications. 3. To determine the association of the post-operative complications with the demographic and clinical variables. MATERIALS AND METHODS: RESEARCH DESIGN: A descriptive design was used to conduct the study. The purpose of the design was to compare and document the post-operative complications arising with the use of two suturing techniques. STUDY POPULATION: The population in this study was all patients diagnosed to have generalized peritonitis, and admitted under the General Surgical Units of the Christian Medical College, Vellore. SAMPLE SIZE: The subjects in this study were all patients diagnosed to have generalized peritonitis and undergoing midline laparotomy. There were 151 subjects enrolled in the study. The rest of the subjects were disqualified from the study for the following reasons: suture technique not known, lost to follow up, and death before 10 days due to causes not attributable to wound complication (discussed in more detail later). SAMPLING TECHNIQUE: All consecutive subjects who fulfilled the inclusion criteria were included in the study. INCLUSION CRITERIA: The following criteria were used for selecting the subjects: 1. Patients over 15 years of age. 2. Suture material must be No. 1 PDS. 3. Suturing technique must be either interrupted or continuous. 4. Subjects who had a post-operative follow up of at least 10 days. 5. Subjects who expire within the first 10 days due to a complication under study. EXCLUSION CRITERIA: The following criteria were used for excluding individuals: 1. Subjects with localized peritonitis. 2. Subjects who underwent any incision other than midline laparotomy. 3. History of previous operation using a midline incision. CONCLUSION: The ideal method of abdominal wound closure has not been discovered. The ideal method should be technically so simple that the results are as good in the hands of the trainee as in those of the surgical master; it should be free from the post-operative wound complications; it should be comfortable to the patient; and it should leave a reasonable aesthetic scar. The interrupted technique of abdominal fascial closure is advocated in decreasing both early and late post-operative wound complications in a contaminated wound. Various modifiable risk factors have been described to decrease the rate of development of post-operative wound complications. Although this study provides insight on proper surgical technique; however, much remains to be unraveled in the Pandora’s Box.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | two suturing techniques ; ; post-operative complications ; generalized peritonitis ; underwent Midline Laparotomy. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 04 May 2018 03:34 |
| Last Modified: | 04 May 2018 03:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7427 |
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