A Prospective Comparative Study On Small Bites Versus Large Bites Stitch For Fascial Closure Of Midline Abdominal IncisionsIn Patients Undergoing Emergency Laparotomy For Peptic Perforation Peritonitis

Aim: To compare the outcome of midline abdominal wound closure after a small tissue bites versus a large tissue bite. Materials and Methods: A prospective randomized study was conducted in JLN Medical College & Hospital, Ajmer, from June 2022 to June 2024, for abdominal surgical problems requiring emergency laparotomy in the General Surgical ward and emergency ward. Patients were aged 12 years and above and of both sexes. Patients were randomized to wound closure with either a small or large tissue bites by lottery method into group A and group B. Group A (n=40): abdominal wall closed by Using Small Tissue Bites technique. Small tissue bites were placed at least 5 mm from the wound edge 5 mm apart. In Group B (n=40) the abdominal wall was closed by using the large tissue bites technique. Large tissue bites were placed 10 mm from the wound edge and 10 mm apart, and included only the aponeurosis in the stitches with or without the peritoneum. Results: In this study mean age in Group A (Small Bite) is 47.6+17.95 years and in Group B (Large Bite) 47.5+15.29 years. 6 patients in Group A and 16 patients in Group B developed SSI. When comparing both the groups, the p value was 0.910 (NS). Wound dehiscence developed in 4 patients (10%) in Group A and in 5 patients (12.5%) in Group B. When comparing both groups, the p value was 0.630 (NS). Incisional hernia developed in 3 patients in Group A while 8 patients in Group B developed incisional hernia. When comparing both the groups the p-value was 0.782 (NS). In Group A, the ratio of mean SL to WL was less than or equal to 4.5: 1 it was in 17 cases (42.5%) and in Group B, it was in 21 cases (52.5%). In Group B, the ratio of mean SL to WL was more than 4.5: 1 it was in 23 cases (57.5%), and in Group B, it was in 19 cases (47.5%), and the p-value was 0.3704 (NS). In Group A, time of fascial closure less than and equal to 10 minutes it was in 4 cases (10%) and in Group B it was in 32 cases (80%) and In Group A, time of facial closure more than 10 minutes it was in 36 cases (90%) and in Group B it was in 8 cases (20%), The mean time in small bite group was 12.8+1.86 and in large bite group it was 9.25+1.48 mins. The p-value is 0.0138 (Sig.). Conclusion: The small bite suture technique offers several significant advantages over the large bite suture technique for fascial closure in midline abdominal incision in terms of post-operative complications such as Surgical Site infection, Wound Dehiscence, Incisional Hernia, post-operative pain and duration of hospital stay.