Practices of abdominal fascial closure and related complications following elective midline laparotomy at Muhimbili national hospital

Abstract

Background: Midline laparotomy is the commonest approach for abdominal operations. The techniques and sutures used for abdominal fascial closure following elective midline laparotomy differ among surgeons and among centres worldwide. Faulty techniques and/or suture materials used may lead to a wide range of complications, some with devastating outcomes. Objectives: This study was intended to determine the practices of abdominal fascial closure and related complications following elective midline laparotomy at MNH. Methods: This was a hospital based descriptive prospective study. It included patients who underwent elective midline laparotomy in the units of general surgery, urology and gynaecology between April 2011 and November 2011. All patients were followed up after surgery which lasted until January 2012. Results: One hundred and forty eight patients were eligible for analysis. Among these, 130 (87.8%) were females and 18 (12.2%) were males. The overall average age was 44.7 (SD 13.9) years and ranged from 15 to 90 years. Continuous fascial closure was performed in 147 (99.3%) patients while in only one patient interrupted closure was performed. Likewise, mass closure was favoured (99.3%) as opposed to layered closure (0.7%). Vicryl was the commonly used suture material, 78 (52.7%) patients; followed by prolene 46 (31.1%) patients and PDSII 24 (16.2%). Sutures with size number 1 were used in all patients except one where suture with size number 0 was used. Duration of follow up after surgery varied from 2 months to 9 months; mean duration being 5.8 months (SD 2.0 months). Twelve (8.1%) patients encountered complications; 11 patients had one complication each while one patient had two complications. Complications reported were persistent wound pain (6), wound sepsis (5) and stitch sinus (2). The use of prolene was associated with persistent wound pain, p-value = 0.026; and in fact had higher overall complication rates, p-value = 0.002 vii Conclusion and Recommendations: Uniformity on the techniques of fascial closure after elective midline laparotomy does exist among surgeons in MNH; however the use of different sutures to serve this purpose reflects lack of consensus. Prolene use is associated with persistent wound pain. Factors influencing selection of sutures should be addressed. Long term follow up is crucial for patients who undergo midline laparotomy to assess the occurrence of incisional hernia.