OUTCOME OF PRIMARY V/S DELAYED PRIMARY CLOSURE IN CONTAMINATED AND DIRTY MIDLINE ABDOMINAL SURGERY.

Abstract

Objective: This study was designed to compare the outcome of primary closure (PC) versus delayed primary closure (DPC) technique in contaminated and dirty midline abdominal surgery in terms of wound infection, wound dehiscence & hospital stay. Stydy Design: Comparative observational study. Place And Duration: All units of the General Surgery department of Liaquat University Hospital Hyderabad, for a period of six months from June 2018 to November 2018. Methodology: All patients age between 17-80 years of either gender, I underwent exploratory laparotomy through midline abdominal incision and found to have bilious, fecal or purulent fluid in the peritoneal cavity were included in the study. Patients were divided into two groups. Patients in group-A underwent for PC of abdominal wound and patients in group-B were enrolled for DPC. Postoperative wound infection, wound dehiscence and hospital stay were observed. Results: A total of 124 patients were included in this study. The mean age of patients was 32.4±15.6 years. Male were 84 (67.7%) and 40(32.3%) were female. The male to female ratio was 2:1. Out of 124 patients, 59 were included in group-A and 65 were placed in group-B.The overall surgical site infection rate was 65.4%.The rate of wound infection is significantly low in patients with DPC as compare to PC(P-value <0.05).5 patients develop wound dehiscence in group A while none of the patient develop wound dehiscence in group B. Postoperative hospital stay was shorter in group B (P- value .001) Conclusion: Delayed primary wound closure technique is a suitable option for the management of dirty and contaminated abdominal wound. It significantly lowers the rate of surgical site infection as well as fascial dehiscence without increasing the length of hospital stay.