Comparative Study of Delayed Primary Closure Versus Primary Closure of Contaminated Skin Incision in Exploratory Laparotomy for Intra Abdominal Severe Sepsis

Background: It was thought that whether delayed primary closure (DPC) of contaminated abdominal incision reduces surgical site infection compared with primary closure (PC). The rate of wound infection for contaminated abdominal wound is approximately 2.6% to 42%, but the optimal method of wound closure remains controversial. Aims and objectives: To determine whether delayed primary skin closure of contaminated and dirty abdominal wounds reduces the rate of surgical site infection (SSI) compared with primary skin closure. To observe and collect data compare and contrast tabulated data to draw the conclusion about dressing, use of of antibiotics, patients compliance and tolerance. Method: In this Prospective study Patient diagnosed as acute peritonitis and posted for exploratory laparotomy during the period of April 1 st , 2022 to May 1 st , 2023 were included. The study was conducted at Narendra Modi Medical College and LG Hospital Maninagar Ahmedabad. In this series a total of 100 patients were included and were divided in two groups. Each group had 50 patients. For primary closure group, wounds were closed with monofilament interrupted suture. For Delayed primary closure, skin and subcutaneous tissue are left open and packed with 10 % (betadine) povidone iodine soaked gauge, which was changed daily to collect exudates and give antisepsis to wound. The wound was observed and assessed in post operative period and outcome was drawn. Result: In this entire series, wound infection developed after incision closure was 33%. The primary group had a higher rate of wound infection 54% and delayed primary closure was 12% (P<0.001) and longer length of hospital stay 19.4 days in primary closure group and 16.5days in delayed primary closure group (P<0.002). Conclusion: Laparotomy wound complications are multifactorial, it depends on many factors. A strategy of Delayed Primary closure of contaminated abdominal wound, clinically appears to decrease the rate of wound infection, when compared with Primary Closure without increasing the length hospital of stay.