Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases

Abstract

INTRODUCTION A midline incision is the most commonly used access route for emergency laparotomy as it is simple, quick, bloodless, has best extensibility and provides excellent exposure. 1,2 But it's drawbacks are comparatively increased incidence of postoperative wound dehiscence and an incisional hernia compared to other incisions. 3 Many factors influence wound complications like wound sepsis and dehiscence. Some of the patient related factors are their nutritional status, hypoalbuminaemia, anaemia, immunosuppressed states, renal failure, uncontrolled diabetes, malignancies, steroid therapy and obesity. Other set of factors which influence the strength of repair and healing are related to the technique of suturing. Some of them are the size and type of suture material used (monofilament versus polyfilament, absorbable vs. non-absorbable, natural versuss synthetic) and also the ABSTRACT Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure. Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test. Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p >0.05). Wound dehiscence rate was significantly less in the study group (p < 0.05) compared to control group. Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to seesaw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.