title: Interrupted abdominal closure prevents burst: randomized controlled trial comparing interrupted-x and conventional continuous closures in surgical and gynecological patients.
abstract: Reduction in the risk of abdominal dehiscence with application of interrupted method of laparotomy closure and comparison with risk of burst with continuous method of closure. Three hundred forty eight patients undergoing laparotomy (114-elective gynecology, 114-emergency gynecology, 120-emergency surgery) were randomized into three arms to undergo closure with continuous, interrupted-X, and Modified Smead-Jones suturing techniques. Burst abdomen occurring up to 4 weeks of operation. Twenty-nine (8.33 %) of 348 patients developed burst in the post-operative period. 19 (15.70 %) of 121 patients in continuous arm developed burst. Five of 110 (4.55 %) patients in Interrupted-X arm and 5 of 117 (4.27 %) patients in Modified Smead-Jones arm developed burst. Interrupted suturing was associated with significant reduction in risk of burst when compared with continuous closure. Important predictors of burst were Intraperitoneal sepsis, cough, uremia, and surgical site infection.
authors.affiliation: Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Agrawal
authors.affiliation: Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Pamit
authors.initials: P
authors.lastname: Tiwari
authors.affiliation: Department of Gynecology and Obstetrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New-Delhi, 110029 Delhi India.
authors.forename: Arpit
authors.initials: A
authors.lastname: Rao
authors.affiliation: Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Niladhar S
authors.initials: NS
authors.lastname: Hadke
authors.affiliation: Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Adhikari
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New-Delhi, 110029 Delhi India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Srivastava
keywords: Abdominal wound dehiscence; Burst abdomen; Emergency laparatomy; Gynecological surgery; Interrupted X suture; Prof Hughes’ far & near suture; Randomized trial