Comparative study between mass closure (single layer) vs layer wise closure of midline incisions

Background: In abdominal surgery correct method of closing wounds is of great importance. The ideal method should be technically simple so that the results are as good in the hands of trainee as in those of master surgeons. Until recently layered closure of the abdominal wounds was considered ideal with great emphasis placed on peritoneal layer. It is now fully realized both from clinical observation and animal studies, that healing of incisions takes place by dense fibrous scar that unites the opposing faces of laparotomy wound enmasse. Objective: To compare the outcome of mass closure Vs single layer closure of midline incisions. Methods: 50 patients with midline abdominal incisions operated in PMCH, Patna either in emergency or elective were selected and divided in to two groups. GROUP1 included patients where single layer closure done on the other hand GROUP2 included patients for whom layer wise closure was done. The outcomes in terms of wound infection, wound dehiscence, sinus formation, incisional hernia etc. Were compared. Results: About 1.8% developed wound dehiscence in group1 compared to 7.1 % in group 2. Other complications like suture sinus formation, scar complications, Incisional hernia, were more common in group2 compared to group1. Conclusion: single layer closure method holds the promise for a safe technique of closure with minimal complication.