OUTCOME OF PRIMARY VERSUS SECONDARY CLOSURE OF MIDLINE LAPAROTOMY WOUNDS IN PATIENTS WITH PERITONITIS SECONDARY TO ILEAL PERFORATION
DOI:
https://doi.org/10.71000/wxytyj38Keywords:
Surgical Wound Infection, Surgical Wound Dehiscence, , Laparotomy, Abdominal Injuries, ReoperationAbstract
Background: An important cause of morbidity after contaminated midline laparotomy is surgical site infection (SSI), particularly in ileal perforation peritonitis. Nevertheless, primary closure (PC) versus delayed primary closure (DPC) of the midline incisional wound is controversial, especially in contaminated fields. The purpose of this study was to compare the postoperative outcomes of PC and DC in these patients.
Methods: This prospective, randomized controlled study involved 120 adult patients subjected to midline laparotomy due to ileal perforation peritonitis. It was conducted at Jinnah Postgraduate Medical Center (JPMC), Karachi (April 2024 to March 2025). Group A (received PC, n = 61) and Group B (received DPC, n = 59) were randomly allocated into open-wound initial management, skin-only approximation, and negative-pressure dressing combined, followed by definitive closure when the infection was suppressed. Wound classification followed the CDC (Centers for Disease Control) criteria. Outcomes were monitored daily by inpatient review and follow-up on the 7th, 14th, and 30th postoperative days. Chi-square, t-tests, and Fisher’s exact tests were performed as statistical analyses, and p < 0.05 was considered significant.
Results: 22 (36.1%) patients in the PC group indicated an overall SSI rate compared to 11 (18.6%) in the DPC (p = 0.004). Wound dehiscence occurred more in Group PC, 8 (13.1%) vs. 2 (3.4%), p = 0.02. Wounds healed more slowly in the PC compared to the DPC (21.5 ± 6.3 versus 16.8 ± 5.0 days, p = 0.001). Nevertheless, the overall hospital stay was not significant between the groups (12.4 ± 4.2 days vs. 13.1 ± 4.5 days, p = 0.255). There was no significant difference in mortality rates, 6 (9.8%) vs. 4 (6.8%), p=0.468.
Conclusion: DPC of midline laparotomy wounds in patients with peritonitis due to ileal perforation is associated with a high reduction in SSI rates, reduced wound dehiscence rates, and accelerated wound healing, with no increase in mortality or duration of hospitalization. The DPC may be a safer option in infected surgical areas, particularly in low-resource settings.
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