A Clinical Study of Rectus Sheath Closure Using Continuous Interlocking Technique Versus Intermittent Technique

Background: The manner of rectus sheath closure after midline laparotomy significantly impacts postoperative sequelae, including surgical site infections (SSI), ruptured abdomen, and the development of incisional hernias. Given the contentious issue of the ideal suturing technique, this study was designed to evaluate the efficacy and safety of intermittent versus continuous interlocking suturing procedures for rectus sheath closure in patients undergoing midline laparotomy, a topic of high relevance to abdominal surgeons and researchers. Methodology: A prospective, randomised, controlled experiment was conducted with 70 patients undergoing midline laparotomy, who were evenly allocated into two groups. Group 1 (n=35) had rectus sheath closure with an intermittent suturing approach, whereas Group 2 (n=35) underwent continuous interlocking suture closure. The primary outcome measures comprised surgical site infection, ruptured abdomen, and the development of an incisional hernia. Secondary outcomes evaluated demographic characteristics, surgical complexity, and procedure-specific variables. Statistical analysis was conducted using IBM SPSS Statistics version 26.0, employing independent sample t-tests for continuous variables and chi-square tests for categorical data. The threshold for statistical significance was established at p < 0.05. Results: Both groups had similar baseline characteristics in terms of age (41.40 ± 11.136 vs 44.49 ± 12.224 years, p = 0.274), gender distribution (p = 0.631), diagnostic categories (p = 8.307), and surgical procedures (p = 4.067). The most notable discovery was a substantial disparity in surgical site infection rates between the two methodologies. The intermittent suturing group had a notably low incidence of surgical site infections (SSI) at 2.9% (1/35 patients), in contrast to 25.7% (9/35 patients) in the continuous interlocking group (χ2 = 7.467, p = 0.006), indicating a nine-fold increased risk associated with continuous interlocking sutures. The incidence of burst abdomen did not differ significantly across the groups (5.7% vs. 2.9%, p = 0.555). The incidence of incisional hernia was negligible in both cohorts, with no occurrences in the intermittent group and one case (2.9%) in the continuous group (p = 0.314). Conclusion: The study's findings strongly support the use of the intermittent suturing technique for rectus sheath closure, primarily due to its significantly lower rates of surgical site infections. The ninefold increase in the risk of SSI associated with the continuous interlocking approach is a clinically significant disparity that should prompt a reevaluation of current surgical practices. Although both procedures yielded similar outcomes for burst abdomen and incisional hernia, the significant decrease in infectious sequelae makes intermittent suturing the superior option for rectus sheath closure, especially in high-risk patients and contaminated surgical environments. These findings have significant implications for improving patient outcomes and reducing healthcare expenses associated with postoperative infections.