Layered closure versus mass closure a study of 50 cases at Nishtar hospital, Multan

A comparative study of 50 cases to compare the number of complications after layered closure with mass closure in major abdominal operation conducted in surgical Unit-II, Nishtar Hospital, Multan extending over a period of 3 years from January 2000 to January 2003. In group-A 17 [70%] were male and 8 [30%] were female. In group-B 16 [64%] were male and 9 [36%] were female. Age of the patients varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] were from elective operation and 17 [68%] from emergency. In group-A 6 [24%] had midline incision while 19 [76%] had paramedian incision. In grup-A clean wound wee 12 [48%] and clean contaminated were 13 [52%]. In group-B clean wounds were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patients with chest infection, 2 [8%] with hemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [8%], biliary tract 6 [245], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscence occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength

Comparison of incidence of injury of hollow viscus versus solid organs in blunt abdominal trauma

Fifty patients were chosen for this study who were between 13-50 years of age and had only abdominal injury; laparotomy was done in all the cases. Road side accident was the major cause in 48% patients of blunt abdominal trauma followed fall height, animal kicks, direct blow and fall of heavy objects. Most of the patients injured were males [82%]. Diagnosis was made on clinical grounds in 72% patients. Diagnostic peritoneal lavage was done in 38% cases. Its accuracy was 89.5%. Solid organs were injured more but intestine was the commonest organ [22%]. Reason for the slight disparity between the percentage of organ injury in this study and international studies is prolong transit time taken by the patients to reach the hospital. Average transit time was 18 hours. Since intestinal injuries were not immediately fatal whereas splenic and hepatic injuries were many times fatal before they reached the hospital; this explains the higher incidence of intestinal injuries in this region