Wound Outcome Following Primary and Delayed Primary Skin Closure Techniques After Laparotomy for Non-Traumatic Ileal Perforation: a Randomized Clinical Trial

Agrawal, Vivek; Joshi, Mohit; Gupta, Ashish Kumar; Jain, Bhupendra Kumar

doi:10.1007/s12262-015-1438-x

Cited by 8 publications

(13 citation statements)

References 19 publications

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“…This finding of present study was consistent with reports of other studies. 17 The mortality rate in present study was only 3.8% and is lower than many reports from developing countries where it is reported from 9-22%. Less rates of mortality in present study may be due to improved hospital care, better surgical technique and well developed infra structure.…”

Section: Discussioncontrasting

confidence: 78%

Typhoid ileal perforation: a two-year study at a tertiary care hospital of South India

Markapuram¹,

Rachamalla²,

Satish³

et al. 2018

Int Surg J

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Background: Typhoid fever is an acute febrile illness caused by gram negative bacilli, Salmonella enteritidis serovars typhi. The incidence of typhoid fever varies globally from 140 episodes per 10000-person years in Kolkata to 273 per 10000 in Delhi, India. The present study was done with an aim to assess the risk factors, complications and different surgical techniques in cases of typhoid ileal perforation. The study also identifies and focuses on the post-operative complications in cases of perforation due to typhoid fever.Methods: A prospective study was conducted for a period of two years from June 2105 to May 2017 at a tertiary care hospital on all the cases admitted and operated for typhoid perforation. The data collected was analyzed using SPSS version 15.0 for windows 7.Results: 104 cases with an incidence rate of 8.4% of perforation were included in the study. Males were majority and mean age of the study group was 21.8±10.1 years. The peak incidence of study group was 31-40 years and >60 years. Fever and abdominal pain (rebound tenderness) was the common sign and symptoms. Free fluid and air collection under the diaphragm was the commonest finding in radiographs and ultrasound. Majority of the cases had single perforation (84.62%) and ileum was the most common site of perforation (84.62%). Simple closure with double layering was the commonest surgical procedure performed and the incidence of post-operative complication was 36.5%. Overall mortality in the study was 3.8%. SSI was the commonest post-operative complication.Conclusions: To conclude from our study, typhoid still remains as an endemic disease in spite of improved awareness and better sanitation facilities. Inadequate treatment, misdiagnosis and mismanagement of cases by non-medical practitioners at rural settings may increase the risk of complications

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Section: Discussioncontrasting

confidence: 78%

Typhoid ileal perforation: a two-year study at a tertiary care hospital of South India

Markapuram¹,

Rachamalla²,

Satish³

et al. 2018

Int Surg J

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“…This is achieved by allowing free egress of wound exudates [3]. However, leaving this wound for 3 to 5 days while waiting for delayed primary closure is usually frightening and causes anxiety in patients and their caregivers [9]. This has been one of the reasons why many surgeons practice primary closure of such wounds [7].…”

Section: Discussionmentioning

confidence: 99%

“…The method of skin closure is an important factor that influences the outcome of a surgical wound [9]. Wound closure after laparotomy for typhoid ileal perforation can either be primary or delayed primary closure [10].…”

Section: Introductionmentioning

confidence: 99%

A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria

Abiodun¹,

Gomna²,

Eletta³

et al. 2020

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Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical site infection (SSI). We aimed to document the incidence, severity and management of wound complications when primary closure of abdominal wounds was performed following laparotomy for typhoid ileal perforation. Patients and Methods: This was a retrospective study of all patients who had primary abdominal wound closure following laparotomy for typhoid ileal perforation in Federal Medical Centre, Bida from January 2017 to December 2018. Results: There were 71 patients with the age ranges from 2 to 41 years and their median age was 15 years who had laparotomy for typhoid ileal perforation during the study period. All 71 patients had primary closure of their abdominal wounds, however two of them died within 72 hours of operation and were excluded from the study. There were males 38 (55.1%) and females 31 (44.9%) with a male to female ratio of 1.2:1. There was primary wound healing in 23 (33.3%) patients while 44 (63.8%) of them developed incisional surgical site infections (SSI) and 2 (2.9%) developed organ space SSI. Of the 44 patients that had incisional SSI, 33 (75.0%) were superficial and 11 (25.0%) were deep. Other complications noted from the study were faecal fistulae 3 (4.3%) and incisional hernia (4.3%). Conclusion: Though a high incidence of wound morbidity is not unexpected in situation of primary closure of laparotomy wound for bacteria peritonitis, an aggressive wound management may help to reduce the incidence and severity of wound complications in such situations.

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“…On the other hand delayed primary wound closure prevents the formation of seroma and anaerobic environment in the wound, thus avoiding bacterial proliferation. 23 Another postulate in favour of delayed primary wound closure is that, leaving open the wounds, as in delayed primary wound closure, prevent infection as repeated dressing change accomplishes adequate drainage. 15 Over all incidence of incisional hernia in the present study population was 8.5%, with 7.5% in primary suture group and a slightly higher-9.4% in the delayed primary suture group, though not statistically significant (Table 12).…”

Section: Discussionmentioning

confidence: 99%

“…Similar pattern of organism were seen in a study conducted by Agrawal et al who reported that most common organism isolated from pus culture as Escherichia coli in 35 % followed by mixed growth in 8.8% and Klebsiella 4.4% and Staph aureus, Enterobacter, and Pseudomonas in 1.4% and 7.3%. 23 Jadesh et al who compared primary closure and delayed primary closure demonstrated the most common organism cultured from the wounds as E. coli 13%, Klebsiella 17%, Pseudomonas 21%, Staphylococcus aureus 9%, coagulase negative staphylococci 4%, enterococci 4% and sterile 36%. 28 The method of delayed primary wound closure has the advantage of reducing the numbers of colonic bacteria, particularly anaerobes, contaminating the wound.…”

Section: Discussionmentioning

confidence: 99%

Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

Sasikumar

Mammen

2019

Int Surg J

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Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.

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Wound Outcome Following Primary and Delayed Primary Skin Closure Techniques After Laparotomy for Non-Traumatic Ileal Perforation: a Randomized Clinical Trial

Cited by 8 publications

References 19 publications

Typhoid ileal perforation: a two-year study at a tertiary care hospital of South India

Typhoid ileal perforation: a two-year study at a tertiary care hospital of South India

A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria

Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

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