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Background: Despite advances in surgical techniques and material, abdominal wound closure remains challenging. Most abdominal wall incisions are either midline or paramedian. The value of a particular method of closing is determined by the incidence of early and late wound complications. The best abdominal wound closure technique should be, fast, easy, safe and cost effective. It should also prevent or minimize the early and late complications. This study addresses the midline single-layer closure of the abdominal wound.Methods: The purpose of this study is to evaluate the single layer midline abdominal wound closure. The early and late complications associated with this method are studied, and relevant literature reviewed. The study period is from May 2016 to May 2018, i.e. 24 months. The study group comprises of 52 patients, admitted in the department of surgery SBRKM Government medical college Jagdalpur. In all of them, the midline incisions closed in a single layer by a non-absorbable continuous suture. The skin closed separately. The mean age of the patient is 46.5 years. The male to female ratio is 3:1. Emergency laparotomy done in 35 cases and 17 (38.4%) underwent elective surgeries.Results: In this series 20 (38.4%) patients had wound infection. 10 (19.2%) patients had wound gaping. There was no incisional hernia in six months follow-up.Conclusions: Single layer abdominal wall closure has a definite advantage. It is fast, easy and cost-effective. Continuous running suture with non-absorbable material provides enough strength during healing and is better than interrupted sutures. The incidence of early and late complications is also significantly less. The results are comparable to many meta-analyses and RCT did in this field.

Background: An efficient technique for abdominal wall closure should provide strength and be a barrier against infection. Method of closure and type of suture material are critical aspects of an effective abdominal wall closure after midline laparotomy. Dehiscence of abdominal wounds after closure is a serious complication especially in emergency laparotomies. Our study was done to know whether our method of abdominal closure was helpful in reducing incidence of wound dehiscence.Methods: Present study was carried out as a retrospective randomized clinical study in the department of general surgery, Menoufia University Hospitals for one year starting from March 2017 to March 2018. 168 patients had midline laparotomies (either elective or emergent) for inflammatory, traumatic or neoplastic indications.Results: In present study for this new technique of abdominal wall closure after midline laparotomies, wound infection was noticed in 12/168 (7.2%) cases and 2/168 (1.2%) patients developed wound dehiscence.Conclusions: Present study demonstrates that our new technique (Moharam Repair) of abdominal wall closure after midline laparotomies) is efficient in reducing post-operative wound dehiscence (burst abdomen). So, this technique is applicable, safe, and can minimize morbidities and mortalities related to wound dehiscence (as a short-term complication) after midline exploratory laparotomies (MEL).

Background: To compare and find out the best method of abdominal wall closure in cases peritonitis between subcutaneous negative suction drainage tube and conventional primary skin and subcutaneous closure.Methods: From September 2015 to September 2017, 100 patients who presented at the emergency department with acute abdominal pain and operated for the same, with features s/o peritonitis were enrolled into the study. 50 of them were managed with subcutaneous negative suction drainage tube during abdominal wall closure (Group A). 50 other patients underwent conventional method of abdominal wall closure (Group B). On table pus c/s was sent for all 100 cases. The surgical wound was observed for signs of infection. Any seropurulent collection from the drain or any discharge from the wound was sent for c/s and the results of which were compared with the results of on table pus c/s. If wound dehiscence was noted, secondary suturing was done after the wound healed. The duration of suction drain placement and stay in the hospital were noted in all cases. The results were analyzed with Chi-square test and Student t test (unpaired) and p values were calculated. A p value of less than 0.05 was considered significant.Results: The incidence of SSI was significantly less in Group A (20%) than in Group B (64%). Similarly, wound dehiscence occurred in 30% of SSI cases in Group A as against 87.1% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (8 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay.

Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

Congenital prepubic sinus (CPS) is a very rare congenital anomaly. The baby generally present with discharge from an opening situated in midline below umbilicus to root of penis in male or clitoris in female child. The etiology of this congenital anomaly is not exactly known. There is debate in etiology as one theory support anomalous anterior abdominal wall closure and another support variant of dorsal urethral duplication. Here we are presenting the six cases of CPS with their management and brief discussion on theories that have been proposed for their etiology.