A randomized trial analyzing the effects of primary versus delayed primary closure of incision on wound healing in patients with hollow viscus perforation
Aditya Baksi1, Shamita Chatterjee2, Udipta Ray3, Nilima Nilima4, Washim Firoz Khan1, Niladri Banerjee1
1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
2Department of Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
3Department of General Surgery, Medica Super Speciality Hospital, Kolkata, India
4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Abstract
Objective: Delayed primary closure (DPC) of the skin has been suggested to decrease superficial surgical site infection (SSSI) in patients undergoing surgery for peritonitis secondary to hollow viscus perforation, but there is no consensus. The aim of this study was to compare the outcomes of primary closure (PC) and DPC of the skin in terms of SSSI, fascial dehiscence and length of hospital stay (LOS).
Material and Methods: Sixty patients, undergoing emergency surgery for perforation peritonitis, were randomized to PC (n= 30) and DPC (n= 30). Patients in the DPC group underwent skin closure four or more days after surgery when the wound was clinically considered appropriate for closure. Patients in the PC group had skin closure at the time of surgery.
Results: Incidence of SSSI was significantly less in the DPC group (7.4%) compared to the PC (42.9%) (p= 0.004). However, the median time of DPC was the 10th POD, i.e., these wounds required considerable time to become clinically suitable for closure. Incidence of fascial dehiscence was comparable between the two groups (p= 0.67). Length of hospital stay (LOS) was 13.8 days in the DPC group compared to 13.5 days in PC; the difference was not significant (p= 0.825).
Conclusion: DPC of the skin incision resulted in the reduction of SSSI. However, this did not translate into a reduction in hospital stay, as it took considerable time for these wounds to become appropriate for DPC, thus bringing into question any real advantage of DPC over PC.
Cite this article as: Baksi A, Chatterjee S, Ray U, Nilima N, Khan WF, Banerjee N. A randomized trial analyzing the effects of primary versus delayed primary closure of incision on wound healing in patients with hollow viscus perforation. Turk J Surg 2020; 36 (4): 327-332.
The approval for this study was obtained from Medical College Kolkata Ethics Committee (Decision No: CTRI/2018/02/011973, Date: 17.12.2011).
Concept - A.B., S.C., U.R.; Design - All of authors; Supervision - S.C., U.R.; Materials - All of authors; Data Collection and/or Processing - A.B., W.F.K., N.B.; Analysis and Interpretation - A.B., N.N.; Literature Review - All of authors; Writing Manuscript - A.B., S.C.; Critical Reviews - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.
The authors would like to thank Dr. Ayan Jha, Department of Population and Family Health, Columbia Mailman School of Public Health, for his valuable contribution.