Comparative Analysis of Midline Abdominal Wound Closure Techniques for Preventing Burst Abdomen in Abdominal Emergency Surgery

Objective: To compare postoperative outcomes, including surgical site infection (SSI), burst abdomen, and wound care quality, between continuous and interrupted closure techniques in emergency midline laparotomy. Methods: This prospective cohort study was conducted in the Department of Surgery at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January to July 2025. Patients aged ≥18 years undergoing emergency midline laparotomy were grouped into continuous and interrupted closure cohorts. Demographic, clinical, intraoperative, and postoperative data were collected using a structured proforma. The primary outcome was a burst abdomen during the index hospital admission or within 30 days of surgery. Secondary outcomes included SSI (Centers for Disease Control and Prevention criteria), reoperation, in-hospital mortality, and wound care quality (classified as poor, average, or good). Results: A total of 312 patients, the mean age was 52.0 ±19.0 years. There were 175 (56.1%) males and 137 (43.9%) females. Postoperative outcomes showed an insignificantly higher rate in the continuous closure group compared to the interrupted closure group for good wound care quality (57 [36.5%] vs 42 [26.9%], p-value = 0.102), SSI (85 [54.5%] vs 77 [49.4%], p-value = 0.365), in-hospital mortality (8 [5.1%] vs 7 [4.5%], p-value = 0.791), reoperation (88 [56.4%] vs 78 [50.0%], p-value = 0.257), and burst abdomen within 30 days of surgery (79 [50.6%] vs 65 [41.7%], p-value = 0.112). Conclusion: Continuous closure had better rates of good wound care quality, SSI, in-hospital mortality, reoperation, and burst abdomen within 30 days of surgery compared to interrupted closure, with no significant association between groups.