Personalized surgical strategies: addressing burst abdomen (Interrupted vs continuous fascial closure) in emergency
Pushpendra Malik1, Prakash Raj2, M K Garg2
1Department of Surgery, BPS GMC, Khanpur Kalan, India. drgathwala@gmail.com.
Background:
Suturing techniques play a crucial role in wound healing and the overall outcome of surgical procedures. The debate between the effectiveness of interrupted versus continuous suturing techniques remains unresolved. This study aims to compare the outcomes of these two suturing methods in terms of Burst Abdomen in patients undergoing emergency exploratory laparotomy, with a focus on personalized surgical strategies.
Methods:
This randomized controlled trial was conducted in the Department of General Surgery BPS GMC Khanpur. Ninety patients requiring emergency midline laparotomy were randomized into two groups: Group A (Interrupted Closure) and Group B (Continuous Closure). The rectus sheath was closed using No. 1 Prolene suture, either interrupted or continuous. The primary outcome was the incidence of wound dehiscence, with secondary outcomes including closure time and patient demographics.
Results:
The overall incidence of burst abdomen was higher in the continuous group (14.4%) compared to the interrupted group (6.7%), though this was not statistically significant (p = 0.071). The time taken for rectus closure was significantly longer in the interrupted group (mean 28.36 min) compared to the continuous group (mean 17.31 min, p < 0.0001). Subgroup analysis revealed a significantly lower incidence of burst abdomen in patients with tubercular perforation peritonitis in the interrupted group (7.7%) compared to the continuous group (57.1%, p = 0.01).
Conclusion:
The Study showed that interrupted closure technique showed a lower incidence of burst abdomen and preferred in tubercular perforation peritonitis although it requires more time for closure.
