Effectiveness of Modified Smead Jones Technique Over Conventional Mass Closure for Midline Incision in Emergency Laparotomy
Zaki Ibne Bari *
Department of Surgery, President Abdul Hamid Medical College, Bangladesh.
Farjana Rashid
Department of Radiation Oncology, National Institute of Cancer and Research Hospital, Dhaka, Bangladesh.
Mahedi Afroz Shakil
Department of Surgery, International Medical College and Hospital, Gazipur, Bangladesh.
Sharmin Akter Rime
Department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh.
Fahim Foysal Kollol
Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh.
Noorjahan Akter
Department of Burn and Plastic Surgery, National Institute of Burn and Plastic Surgery, Bangladesh.
Pinjay Biswas
Department of Surgery, Sher-E-Bangla Medical College and Hospital, Barisal, Bangladesh.
Tamanna Rahman Shanta
Department of Surgery, Patuakhali Medical College and Hospital, Patuakhali, Bangladesh.
Shudipta Deby
DGHS, Mohakhali, Dhaka, Bangladesh.
Nabarun Biswas
Department of Surgery, Mymensingh Medical College and Hospital Mymensingh, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: One of the major complications of emergency laparotomy is wound dehiscence, which is the separation of the abdominal wall layers after surgery. Wound dehiscence can lead to evisceration, infection, sepsis even death and requires second surgical intervention and prolonged hospitalization. This study compared effectiveness of modified Smead Jones closure in emergency midline laparotomy with peritonitis and to compare the incidence of wound infection, wound dehiscence, burst abdomen, wound sinus and incisional hernia with conventional techniques.
Materials and Methods: This quasi experimental study was conducted at department of surgery, Mymensingh Medical College and Hospital, over twelve months (March, 2022 to February, 2023), on patients who underwent laparotomy with generalized peritonitis and allocated into two groups: one with conventional midline closure and other with modified Smead Jones technique. Postoperative complications like surgical site infection, wound dehiscence, burst abdomen, wound sinus and incisional hernia were recorded. Demographic and clinical data were collected by semi structured case record form and analysis was done with the help of SPSS (Statistical Package for Social Science) version-27.
Results: The study encompassed total 152 participants, 76 in Group A (conventional closure) and 76 in Group B (Modified Smead Jones closure). Mean BMI values were 25.9±2.62 for Group A and 25.6±2.89 for Group B. Postoperative complications showed that the rates of surgical site infection (23.7% in Group A vs. 21.1% in Group B, p = 0.697), wound dehiscence 15.8% in Group A and 7.9% in Group B (p = 0.132), burst abdomen (9.2% in Group A vs. 5.3% in Group B, p = 0.348) and the rates of wound sinus (1.3% in Group A vs. 3.9% in Group B, p = 0.311) were not statistically significant. The most notable result was the significantly lower incidence of incisional hernia in Group B compared to Group A (9.2% in Group A vs. 1.3% in Group B, p = 0.029). Pain severity was predominantly mild, with 75.0% in Group A and 71.1% in Group B. The mean duration of hospital stay was significantly shorter in Group B (5.13 ± 2.10 days) compared to Group A (6.29 ± 3.07 days), with significant p value (p = 0.007).
Conclusion: The Modified Smead Jones closure demonstrated statistically significant advantage in terms of a shorter hospital stay and reducing the incidence of incisional hernia compared to conventional closure. These findings underscore the promising aspects of the Modified Smead Jones technique and suggest its consideration in emergency laparotomies.
Keywords: Modified Smead Jones technique, conventional mass closure, emergency laparotomy