title: Outcome of primary closure of abdominal wounds following laparotomy for peritonitis in children.
abstract: BACKGROUND
  Primary wound closure following laparotomy for peritonitis is generally believed to be associated with wound complications and long hospital stay. Open wound management has long been the most common practice after laparotomy for peritonitis. Primary closure (PC), however, has recently been advocated to reduce cost and morbidity. This study determined the incidence and severity of wound complications and their impact on hospital stay and overall outcome when PC of abdominal wounds is done following laparotomy for peritonitis.
  
  
  METHODS
  A prospective review of patients who had PC of abdominal wounds following laparotomy for peritonitis over a 6-year period.
  
  
  RESULTS
  Fifty-six children were analysed (35 boys and 21 girls), aged 11 months to 13 years (median: 8 years). The indication for laparotomy was typhoid intestinal perforation 47 (83.9%), perforated appendicitis 4 (7.1%), complicated cholecystitis 3 (5.3%) and penetrating abdominal injury with bowel perforation and intestinal obstruction with bowel perforation, 1 (1.8%) each, respectively. Postoperatively, 34 patients had wound complications. Nine patients (16.1%) had superficial wound infection alone, 12 (21.4%) had superficial wound infection with partial wound dehiscence, 6 (10.7%) had deep wound infection, 7 (12.5%) had deep wound infection with complete wound dehiscence, whereas 22 (39.3%) had no wound complication. Overall, wound complications in 13 (23.2%) patients were considered to be severe, but none resulted in mortality. Hospital stay in patients who developed wound complications was 8-37 days (median: 25 days) and 6-22 days (median: 10 days) in patients who had no wound complications (P = 0.02).
  
  
  CONCLUSIONS
  The rate of wound complications following PC of dirty abdominal wounds remain but PC is safe and gives good healing outcomes.
authors.affiliation: Department of Surgery, Division of Paediatric Surgery, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria.
authors.forename: Stephen Akau
authors.initials: SA
authors.lastname: Kache
authors.affiliation: Department of Surgery, Division of Paediatric Surgery, University of Abuja, Abuja Teaching Hospital, Gwagwalada, Nigeria.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Mshelbwala
authors.affiliation: Department of Surgery, Division of Paediatric Surgery, National Hospital, Abuja, Nigeria.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Ameh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D010538:Peritonitis / Q000601:surgery*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D058106:Wound Closure Techniques; D014945:Wound Healing