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Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial

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Abstract

Purpose

Perforated peptic ulcer (PPU) is a life-threatening complication of peptic ulcer disease. This condition is characterized by a dirty abdomen that predisposes to postoperative wound infection. Delayed primary skin closure is occasionally preferred over primary closure to reduce the risk of surgical site infection in dirty abdominal wounds. In primary skin closure, the skin is sutured immediately after surgery. Meanwhile, in delayed primary skin closure, the incision is left open, and sutured after 2–5 days. The current research aimed to compare the risk for surgical site infection, length of hospitalization, and mortality rate between primary versus delayed primary skin closure among patients who underwent surgery for PPU.

Methods

This single-blind randomized clinical trial included 120 patients who were randomly allocated into the primary and delayed primary closure groups. A research assistant who was blinded to the study examined the wounds for surgical site infection based on the 1992 Center for Disease Control criteria. The outcomes were mortality rate and duration of hospitalization.

Results

The delayed primary and primary closure groups did not significantly differ in terms of postsurgical wound infection occurring on the 3rd, 7th, 14th, and 30th days after surgery, mortality rate, and duration of hospitalization.

Conclusion

In patients who underwent surgery for PPU, delayed primary closure is not recommended over primary closure due to the risk of postoperative surgical site infection.

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Acknowledgements

The authors thank Dr. Seyed Hamidreza Mirbehbahani, for his sincere cooperation in conducting this study and writing the manuscript.

Funding

This study was funded by the Vice-Chancellor’s Office in Research Affaires Shahid Beheshti University of Medical Sciences (grant numbers 0990/2018).

Author information

Authors and Affiliations

  1. Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Arash Mohammadi Tofigh

  2. Department of Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Shervan Family

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  1. Arash Mohammadi Tofigh
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Contributions

AMT participated in the study design, validation of data, manuscription of the study, and revision of the manuscript. SF also contributed in the sample collection, patients’ surgery, follow-up, statistical analysis, manuscription of the study, and revision of the manuscript.

Corresponding author

Correspondence to Arash Mohammadi Tofigh.

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Ethical approval

All procedures performed in this study were in accordance and approved by the ethical committee of the Shahid Beheshti University of Medical Sciences (IR.SBMU.MSP.REC.1398.313), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The protocol of this study was registered as a clinical trial. (IRCT20200404046936N1).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Arash Mohammadi Tofigh has received research grants from Shahid Beheshti University of Medical Sciences. Shervan Family declares that he has no conflict of interest.

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Tofigh, A.M., Family, S. Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial. Langenbecks Arch Surg 407, 1471–1478 (2022). https://doi.org/10.1007/s00423-021-02405-4

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  • DOI: https://doi.org/10.1007/s00423-021-02405-4

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