A Comparative Study of Polydioxanone and Nylon for Abdominal Wall Closure With Interrupted Figure of Eight in Peritonitis Cases

Abstract

Background: In emergency and elective settings, some surgeons prefer continuous or interrupted closure of abdominal fascia, because in a continuous suturing, cutting out of even a single bite of tissue leads to opening of the entire wound and high risk of burst abdomen, whereas in interrupted method, they found much lower risk of burst abdomen. The aim is to assess the complication rate with the same closure technique between two different sutures. The best suture is one that maintains tensile strength throughout the healing process with good tissue approximation and less wound infection, is well tolerated by patient and is technically simple and expedient. The aim was to compare the non-absorbable sutures (nylon) and delayed absorbable sutures (polydioxanone (PDS)) for abdominal wall closure in cases of peritonitis. We used a different technique to close the abdominal wall fascia and study the postoperative complications.

Methods: This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala from March 2014 to April 2015, a single unit by a single surgeon. A total of 60 patients underwent interrupted closure of abdominal fascia by figure of eight techniques with polyamide (nylon No. 1) suture in group A and polydiaxanone (PDS No. 1) suture in group B. The incidence rates of wound infection, dehiscence, suture sinus formation and incisional hernia were recorded. Patients were followed up for a period of 1 year.

Results: Out of the 60 patients, the rates of wound pain, discharge and dehiscence in group A were 30%, 23.3% and 26.7% and in group B were 6.7%, 16.6% and 23.3%. There was 0 burst abdomen in group A compared to one burst abdomen in group B. Suture sinus formation, chronic wound infection and stitch granuloma was one each in group A and was 0 in group B. Incisional hernia was not found in any of the group. We have concluded that condition of the wound depends on the comorbidity of the patient like smoking, malnutrition, and old peritonitis. It also mainly depends on the technique used for closure of the wound and also on the material used.

Conclusion: Though wound complications were found more in non-absorbable suture but the rate of wound complications between the two sutures was found insignificant. The purpose of the study is to assess the presence of differences in abdominal wall closure in patients with risk criteria, with the same closure technique between slowly absorbable sutures and non-absorbable sutures. Sutures were placed and tied such that fascial edges were well approximated but not compressed tightly together.




J Curr Surg. 2016;6(3-4):65-72
doi: https://doi.org/10.14740/jcs306e