The closure debate: A prospective comparative study of mesh suture repair v/s Conventional mass closure operated at tertiary care centre

Abstract Background: Traditionally, a laparotomy wound is closed as mass closure, where the fascial layers are closed with single suture. The optimal approach to abdominal wound closure has yet to be determined. Ideally it should be technically straightforward, simple, cost-efficient, reduced risk of immediate and long term complication ensuring equally effective outcomes regardless of whether it is performed by a trainee or an experienced surgeon. Recently, a new closure technique known as the mesh-sutured method has gained popularity and has shown reduced complications than conventional mass closure method. Aims and Objectives · To compare effectiveness of mesh sutured repair vs. conventional mass closure of midline laparotomy · To study feasibility and safety of mesh sutured repair. · To compare the occurrence of wound infection, dehiscence and early incisional hernia in conventional mass closure and mesh sutured repair. Setting and design: This study was performed in P.D.U. Government medical college and hospital, Rajkot (Gujarat) in patients undergoingmidline laparotomy, either planned or emergency. Materials and Methods: A total of 100 patients were enrolled in the study, with 50 undergoing conventional mass closure and the remaining 50 receiving closure using the mesh-sutured repair technique. Randomization was done by binary distribution to eliminate bias. Patients were monitored during the post-operative days for outcome of the procedure and complications such as wound infection, dehiscence and incisional hernia at regular interval. Results: This study had shown significantly less rate of infection, dehiscence and incisional hernia in mesh sutured repair as compared to conventional mass closure. Conclusion: This newer technique of mesh-sutured repair provides distinct advantages over the conventional mass closure method like lower incidence of wound infection and decreased rate of incisional hernia. However, the actual incidence of incisional hernia could not be accurately determined due to short duration of study and limited sample size.