The standard procedure for closure of a laparotomy wound is multilayer closure by chromic catgut. Unpredictable nature and shortened absorption of catgut compelled surgeons to go for nonabsorbable sutures. The incidence of laparotomy wound dehiscence decreased significantly when, in 1941, Jones at the Cleveland Clinic used ‘mass closure’ with ‘figure of 8’ stainless steel wires in controlled trials with both monolayer absorbable sutures and multilayered absorbable & nonabsorbable sutures, which clearly demonstrated the superiority of single-layer closure with nonabsorbable suture material. We have studied 100 cases closed by a modified single layer of abdominal wound closure.

OBJECTIVES

• To observe the patient for burst abdomen
• To observe the patient for incisional hernia in post op period for minimum 1 year

Study Setting: Study was done at Guru Gobindsingh Government Hospital, S.U. 6, Jamnagar

Study design:  It was an observational study conducted at Guru Gobindsingh Government Hospital, S.U. 6, Jamnagar

Study subject: Study has included patients those who were admitted with various clinical conditions at Guru Gobindsingh Government Hospital S.U. 6, Jamnagar

Inclusion criteria :

• Age of patient more than 18 years.
• Patients undergoing elective and emergency surgery requiring abdominal wound closure
• Consent to participate in study.

Exclusion criteria:

• Age less than 18 years or more than 80 years.
• Patient has undergone previous surgery.
• Patient on Immunosuppressants (Anticancer drugs, Corticosteroids).
• Non-compliant patient.
• Patient unfit for surgery.

Sampling Size : 100

Sampling Method: Convenient Sampling

Study period: October 2019 to October 2020 (1 year)

Data Collection:

• The study was presented to Institutional Ethics Committee (IEC) for ethical clearance, after getting clearance form IEC the study was started.
• All selected subjects were approached and personally met & briefed about the study.
• After taking informed consent, a detailed questionnaire was administered to the selected patients, according to their convenience. Strict confidentiality was employed in carrying out the survey and use of information provided by each respondent.
• If study participants were not available due to some reasons, they were re-approached after some days. Even after two time trials, if they were not available or not ready to give information, were considered under non-response.
• After completion of operative procedure, all layers except subcutaneous tissue and skin were closed with monofilament nylon No.1 size mounted on a large half circle cutting needle
• Each patient was followed up after 1 month of operation for any complications.

Data analysis: Collected data was entered in the excel data sheet and data analysis done with the help of Epi. Info.7.2 software.

Statistical method: Data was cleaned, Validated and Analysed by Epi. Info 7 software.

Descriptive Statistics:

• For continuous variable range, mean and standard deviation were calculated and for categorical variables proportion and percentage were obtained.

Bi-Variate analysis:

• To know the association between dependent and independent variable chi-square, t-test applied accordingly.

Ethical issue:- The study was presented to Institutional Ethics Committee for ethical clearance. The IEC has permitted to carry out study and letter attached. A written informed consent has been obtained from the subjects after full explanation of   the requirement of the study. There has not been any interference or influence of research process on the treatment of the patient. All the information collected was strictly used for study purpose and confidentiality was strictly maintained. This was also ensured to study participants before staring study. The Consent Form and Participant Information Sheet are attached as annexure.

Advantages of Modified single layer closure are:

• Abdomen can be closed rapidly even when the contents are under tension.
• Closure is very secure and allows for early mobilization
• Wound can be rapidly re-opened if second laparotomy is needed
• Less suture material is used
• Economically cheaper

In present study we observed,

• 4 cases of burst abdomen were noted during the present study
• 8 cases of incisional hernia were noted out of all the patients, of which 3 were operated in elective OT and 5 in emergency; 5 developed post-op stitch line infection and rest did not and all 8 of these had some kind of factor predisposing to development of incisional hernia.

We recommend the use of modified single layer closure of abdominal wounds in all routine as well as emergency operations, in well nourished as well as serious and debilitated patients. However, this is a very short study with shorted duration of follow-up so a longer study is required with a larger number of cases for final conclusions.

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