Abdominal closure with interrupted ‘X’ sutures prevent burst abdomen better when compared with continuous mass closure: A randomised trial in patients with perforative peritonitis

Abstract

Introduction

Burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. It has a significant impact on health care cost, both for the patient and the hospital.

Objective

To compare the incidence of burst abdomen with two different techniques of midline vertical laparotomy wound closure, i.e. by interrupted mass closure technique (using the ‘X’ suture method) and continuous mass closure technique.

Methods

Two hundred patients who underwent vertical midline laparotomy for perforative peritonitis were included in this study. The patients were randomized to either an interrupted X technique (Group I) or a continuous closure (Group II), both using No1 polypropylene.

Results

The age of the patients was between 12 and 72 years. In group I, the mean age was 36.05 years and in group II it was 42.60 years. In group I, only one patient (1.04%) developed burst abdomen, while in group II 14 patients (14.58%) developed burst abdomen. This was found to be statistically significant [²(1) = 12.694, p=0,000].

Conclusion

The closure of midline laparotomy wounds by interrupted mass closure using the x suture technique is a better closure method with a low rate of wound dehiscence, as compared to continuous suturing technique with the same suture material. Anemia, cough and abdominal distension are significant risk factors for abdominal burst.