Abstract:
A clinical trial was done to compare the complication rates in
clean- contaminated and contaminated laparotomy wounds closed
primarily and those left open in the surgical department, Muhimbili
National Hospital from January 2001 to September 2001.
The objectives of the study were to determine the proportion of patients
exhibiting pus discharge or wound dehiscence within four weeks of
laparotomy, to determine the duration of time patients require wound
dressing following laparotomy, to determine the time required to declare
the wound healed from the time of laparotomy, to determine the
influence of wound complications on mortality, and finally to determine
the proportion of patients developing incisional hernia within six months
of laparotomy.
In this study, all patients received Ceftriaxone Sodium (Powercef ®) as a
prophylactic antibiotic at the time of induction of anaesthesia. The
wound infection rate was 30.2% for those wounds left open compared to
2. 1 % for those wounds closed primarily. This difference is statistically
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significant (p=O.002). It required a longer duration of time for dressing
those wounds left open compared to those closed primarily, the average
being 16 days compared to 11 respectively (P=O.0002). There was no
significant difference in the development of healing ridge, wound
dehiscence, or incisional hernia between the two groups (p>O.05). There
was no significant difference in the mean levels of haemoglobin and
WBe count between the two groups (p>O.05). No death was related to
wound complication.
It was observed that the major complication from clean-contaminated
\
and contaminated laparotomy wound is superficial wound infection
with higher rate in open wounds compared to closed wounds. Open
wounds require a longer period of dressing than closed wounds. It was
difficult to conclude on the development of incisional hernia due to
small number of patients who could be followed up to six months of
laparotomy.
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It is recommended that clean- contaminated and contaminated
laparotomy wounds be closed primarily if no gross spillage of visceral
contents occurs during operation and a patient receives prophylactic
antibiotics. Surgical wound dressings should not be changed unless
there is evidence of infection or on the day of suture removal.
Wound surveillance is required. Further studies are needed to determine
the risk factors for open wounds to develop infection, to compare
effectiveness of different types of antibiotics as well as elective against
emergency operations.
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