04Jan 2018

COMPARISON BETWEEN DELAYED PRIMARY CLOSURE AND IMMEDIATE PRIMARY CLOSURE OF ABDOMINAL INCISIONS IN PATIENTS WITH SEPTIC PERITONITIS.

  • Department of General surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: It is still a point of controversy if performing delayed primary closure (DPC) of abdominal incisions in cases of abdominal septic operations could be able to reduce incidence of surgical-site infection and its bad long term sequels in comparison with immediate primary closure (PC). The Aim: To compare between delayed primary closure and immediate primary closure of abdominal incisions, in patients with peritonitis that results from septic operations regarding superficial surgical site infection. Patients & Methods: we have carried out such study on 60 patients with septic peritonitis that were collected and operated surgically during 2 years in in Department of General Surgery, Zagazig University Hospital. We have divided our cases into 2 groups; Group (1): cases that are managed by immediate PC of the skin and subcutaneous tissue using polypropylene sutures and insertion of subcutaneous drain. Group (2): included cases that are managed by DPC of the skin and subcutaneous tissue, using polypropylene sutures and without insertion of drain. We have followed all patients for 2 weeks for; infection or dehiscence of the wound and for occurrence of burst abdomen, seroma or sub cutaneous collection. Results: we have detected that DPC is better than immediate PC as regard decreasing incidence of wound infection & dehiscence (p=0,009), less liability for occurrence of burst abdomen (p=0.042), sub cutaneous collection (p=0.003) and seroma (p<0.001). Conclusion: performing DPC will be better than immediate PC in management of patients with septic peritonitis.

  1. Nasib G, Inamullah S and Bashir A (2015): “Laparotomy for peritonitis: Primary or delayed primary closure?”. J Ayub Med. Coll. Abbotttabad ., 27 (3).
  2. Mishra S, Tiwany S and Mishra M (2014): “An introduction of tertiary peritonitis”. J Emerg Trauma Shock, 7 (2): 121-3.
  3. Siribumrungwonga B , Srikuea K and Thakkinstian A (2013) : “ Comparison of superficial surgical-site infection between delayed primary and primary wound closures in ruptured appendicitis”. Asian J Surg., 37 (3) 120-4.
  4. Lee JH, Park YS and Choi JS (2010) : The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol. 20:97e105.
  5. Noudeh YJ, Sadigh N and Ahmadnia AY (2007): Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. Int J Surg.,5:95e98.
  6. Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J and Fraser VJ (2008): Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg.,143:53e60 discussion 61.
  7. Kache S, Mshelbwala PH and Ameh E (2016): “Outcome of primary closure of abdominal wounds following laparotomy for peritonitis in children”. AFR J pediatric Surg., 13 (4): 185-188.
  8. Bhangu A, Singh P and Lundy J (2013): “ Systemic review and meta-analysis of randomized clinical trials comparing primary VS delayed primary skin closure in contaminated and dirty abdominal? incisions”.? JAMA Surg., 148 (8): 779-86.
  9. Stone HH, Hester TR (1972). Topical antibiotic and delayed primary closure in the management of contaminated surgical incisions. J Surg Res; 12:70e6.
  10. Stone HH, Hester TR. Incisional and peritoneal infection after emergency celiotomy. Ann Surg 1973; 177:669e78
  11. Berry J, Malt RA (1984). Appendicitis near its centenary. Ann Surg; 200: 567e75.
  12. Raahave D, Friis-Moller A (1986), Bjerre-Jepsen B. The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. Arch Surg 1986; 121:924e9.
  13. Centers for Disease Control. (1996). The National Infection Surveillance System: the national nosocomial infection surveillance (NNIS) report, data summary from October 1986e1996. Am J Infect Control 24:380e8.
  14. Anand Dayama*, Catherine A. Fontecha, Shahin Foroutan, Jonathan Lu, (2017). Comparison of surgical incision complete closure versus leaving skin open in wound class IV in emergent colon surgery The American Journal of Surgery xxx 1e5.
  15. Duttaroy DD, Jitendra J, Duttaroy B, et al. (2009). Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial. Surg Infect. 10:129e136.
  16. Yellin AE, Berne TV, Heseltine PN(1993). Prospective randomized study of two different doses of clindamycin admixed with gentamicin in the management of perforated appendicitis. Am Surg; 4:248e55.
  17. Ruey-An Chiang*, Shan-Long Chen, Yao-Chung Tsai (2012). Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial? Journal of the Chinese Medical Association 75 156e159
  18. Chiang RA, Chen SL, Tsai YC, Bair MJ (2006). Comparison of primary wound closure versus open wound management in perforated appendicitis. J Formos Med Assoc; 105:791e5.
  19. Henry MC, Moss RL (2005). Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis. Pediatr Surg Int. 21:625e630.
  20. Boonying Siribumrungwong a,b,*, Kanoklada Srikuea a, Ammarin Thakkinstian (2014). Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis Asian Journal of Surgery 37, 120e124.

[Ahmed Raafat, Fady M. Habib, Ahmed M. Sallam and Loay M. Gertallah. (2018); COMPARISON BETWEEN DELAYED PRIMARY CLOSURE AND IMMEDIATE PRIMARY CLOSURE OF ABDOMINAL INCISIONS IN PATIENTS WITH SEPTIC PERITONITIS. Int. J. of Adv. Res. 6 (Jan). 261-268] (ISSN 2320-5407). www.journalijar.com

Ahmed Raafat
Department of General surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

DOI:

Article DOI: 10.21474/IJAR01/6213      
DOI URL: http://dx.doi.org/10.21474/IJAR01/6213

Download Full Paper

Download PDF No. of Downloads: 55 | No. of Views: 210