Comparison of Incidence of Superficial Surgical Site Infection in Primary Closure over Drain versus Delayed Primary Closure in Patients Undergoing Exploratory Laparotomy for Peritonitis

Abstract

Objective: To document difference in incidence of superficial surgical site infection (SSSI) following primary
wound closure over a drain versus delayed wound closure after exploratory laparotomy for generalized
peritonitis. Surgical Site infection (SSI) is a common complication after surgery. Exploratory laparotomy for
perforation is one of the common cases faced by surgeons in the emergency. Post-surgery infection after such
cases is expected. Wound infection leads to increased patient morbidity and cost. Various attempts have been
done to limit surgical site infection
Methodology: A prospective cross-sectional observational study was carried out at Surgical Unit-II, Services
Hospital, Lahore, from January 2016 to December 2020. Patients between the ages of 12 and 65 years who
had presented in the surgical emergency with peritonitis requiring exploratory laparotomy were enrolled.
Approval from Institutional Review Board and written informed consent from all the patients were obtained.
Midline laparotomy was made in all cases. In group A, primary closure of wound over a corrugated rubber
drain (CRD) was done. In group B, each patient’s wound was left open for twice a day dressing with saline soaked gauze with delayed closure on 5th post-operative day. After surgery, patients were shifted to ward and were followed-up there for seven days. Then patients were discharged and were followed up in OPD weekly up to the 30th day after surgery. Wounds were examined at follow up for SSSI. The data was entered and analyzed through SPSS version 20. Comparison of frequency of SSI in both groups by using chi-square test
was done using p-value =0.05 as significant.
Results: Mean age of the participants was 35.51±14.11 years with 118 (60.20%) males and 78 (39.80%)
females. Total of 23 (11.73%) patients had SSI and 173 (88.26%) patients had no SSI. No statistical difference
of SSSI was seen between both groups.
Conclusion: No significant difference was found in the incidence of SSSIs between primary closure over a
drain and delayed wound closure following exploratory laparotomy for generalized peritonitis.
Key Words: Delayed primary closure, drain, primary closure, superficial surgical site infection