Prevention of burst abdominal wound by a new technique: A randomized trial comparing continuous versus interrupted X-suture

Background: Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. It's prevention is important to reduce post operative morbidity and mortality
Research Hypothesis: The application of interrupted X-sutures reduces the risk of burst in midline laparotomy wounds.
Aims: To compare the risks of burst with continuous versus interrupted suturing in midline laparotomy wounds.
Setting: Surgical Wards of All India Institute of Medical Sciences (AIIMS), a tertiary care center.
Design: Open randomised trial with two arms.
Material and Methods: One hundred patients undergoing emergency laparotomy and 110 patients undergoing elective laparotomy through a midline vertical incision were randomized after informed consent, to either a continuous closure or an interrupted X technique.
Main Outcome Variable: The risk of burst abdomen diagnosed by a consultant. Predictor Variables: intraperitoneal sepsis, abdominal distension, cough, diabetes, malignancy, anaemia, hypoxia, uraemia, hypoalbuminaemia.
Statistical Analysis: The risk of burst in each group and relative risk (RR) of burst (using continuous group as the reference category) were caluculated.
Results: There were one burst (out of 46) in the X suture group and 8 bursts (out of 54) in the continuous arm in the emergency group. The RR for burst (continuous group as the reference category) was 0.15 (95% C.I. : 0.02 to 1.13, P=0.028).
Conclusion: The risk of burst in the emergency group is less with interrupted X method of closure. Sepsis, cough, anaemia, malnutrition and abdominal distension are significant risk factors for burst.

Keywords
Abdominal wound dehiscence, Burst abdomen, Suture technique, Randomized trial, Logistic regression, Emergency laparotomy