Ram Milan Prajapati
Associate Professor, Department of General Surgery, Muzaffarnagar Medical College and Hospital, Ghasipura, Muzaffarnagar (U.P.)
Abstract
BACKGROUND:
Early in embryonic development, the lateral plate of the intraembryonic mesoderm initiates the development of the abdominal wall. The embryo at this stage is made up of three main layers: the mesoderm, the inner endoderm, which provides nutrients, and the ectoderm, which serves as the outside protective layer. The developing abdominal wall or somatopleure is formed by proliferating cells that are segmented off of the intraembryonic mesoderm into myotomes or somites. The transversus abdominis and the internal and external oblique muscles are ultimately derived from the three layers of the growing mesoderm of the future anterolateral abdominal wall.
AIM: To compare the efficiency of non-absorbable versus delayed absorbable suture material in the closure of the abdominal fascia after midline laparotomy.
MATERIAL AND METHOD:
This is a single institution-based randomized trial conducted at the Hospital in the endoscopic unit of the Department of Surgery. The topic was approved by the Institutional Ethics Committee of the University. The required sample size was 200 which has been calculated with help of Epi Info ™ 3.5.3 software. However, due to the pandemic and the reduction in OPD and emergency admissions, there was a reduction in sample size, and we were able to achieve 100 patients during my study tenure. Patients who were operated on by midline laparotomy in the department of General Surgery, during the aforementioned study period.
RESULTS:
In the PDS group, there were 50 cases out of which 2 cases had wound dehiscence. In 50 cases of Polydioxanone, the overall incidence of wound dehiscence was 5.5%. In the Polypropylene, out of 50 cases, 5 cases had wound dehiscence. In 55 cases of Polypropylene (PPL) dehiscence rate was 14.5%. Using the chi-square test there is no statistical significance in the incidence of suture sinus between the two groups. In the PDS group, there were 50 cases out of which 0 cases had incisional hernia with 0% incidence. In Polypropylene, out of 50 cases, 2 cases had incisional hernia with an incidence of 3.6%. higher incidence of wound infection in emergency cases in the case of PDS, and amongst Polypropylene (PPL) incidence of wound infection was higher in emergency cases.
CONCLUSION:
Based on the observations made in this study, it has been concluded that the continuous self-anchored interlocking suture technique using no.1 Polydioxanone (PDS) for closure of midline laparotomy incision is superior to no.1 Polypropylene (PPL) suture material are superior in preventing major post-operative complication wound complications like wound infection, dehiscence, incisional hernia & suture sinus. Duration of operation and stay in hospital is similar in both the groups. PDS was superior to Prolene with respect to impact on the patient’s quality of life considering complications. Thus, there was an advantage of Polydioxanone (PDS II) suture material over Polypropylene (Prolene) suture material.
KEYWORDS: Abdominoperineal resection, Gastric outlet obstruction, Abnormal Renal Parameters, Intestinal obstruction, Abdominal Wound Closure