Evaluation of incision related complication in emergent abdominal fascial closure with barbed vs non-barbed suture type in hollow viscous perforation: randomized clinical trial in north Indian population

Midline laparotomy incisions provide rapid access to the abdomen where keyhole surgery may be  inadequate specially in emergency cases . Abdominal wall dehiscence  incidence ranges between 2 and 5.5% after elective laparotomy and 8.5–45% after emergency laparotomy and typically occurs between the 6th and 12th postoperative day(1,5,6)

Prophylactic use of antibiotics, mechanical bowel preparation, hair removal at the surgical site, skin disinfection, hand decontamination, and the use of sterile gloves and gowns are some of the recent advancements in the prevention of surgical site infections (SSIs). (7) Suture used for abdominal wall closure is another factor that may have an impact on SSI. The most current method for closing the abdominal fascia involves using absorbable monofilament sutures coated with triclosan. That being said, evisceration rates are elevated following unclean surgery and can up to 15% (8)In order to prevent segmental ischaemia, tissue necrosis, and secondary infection, it’s also critical to provide a uniform distribution of tension throughout the suture, as seen with barbed sutures (9)

In a study done by Ruiz-Tovar et al found that TCB suture reduces the incidence of SSI and acute evisceration compared with standard fascial closure with triclosan-coated polydioxanone (PDS) looped suture and noncoated PDS looped suture in emergency nontraumatic laparotomy(10).The limitation of above study is suboptimal estimation of the SSI rate in the control group for the sample size calculation, might have led to a certain underpower of the study. The above study also did not include trauma laparotomy.

There are no other randomized clinical trial study to support or refute the findings noted by Ruiz-Tovar et al .As far as we are aware, no research has examined the impact of closing abdominal fascia with barbed sutures following unclean surgery in Indian subcontinent. In this study, we are concentrating on a specific patient population:  peritonitis due to hollow viscous perforation, who are more likely to experience wound degradation and surgical site infections.