SKIN CLOSURE IN LAPAROTOMY

DELAYED VERSUS PRIMARY CLOSURE PERFORMED FOR GENERALIZED PERITONITIS

Abstract

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Design and Duration: Quasi experimental study from September, 2006 to March, 2007. Setting: Surgical floor of Allied Hospital, (Punjab Medical College) Faisalabad. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Results: Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients (group A) were left open and closed on 4th day while that of next thirty patients (group B) closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence (16.66 %). Four belonged to group A(13.33%) and six belonged to group B(20 %) (p<0.05). In advancing age the infection rate was significantly high in the same group (p <0.01). Regarding hospital stay of patients of two groups the difference was statistically significant. Group A (mean=7.77, std. dev=2.029 and std. error of mean=0.370). Group B (mean=10.30, std. dev=4.822 and std. error of mean=0.880). Regarding age the difference was not statistically significant between two groups. Group A (mean 30.47, std. dev=10.099 and std error of mean=1.844). The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. Conclusions: No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care.