COMPARISON OF CONVENTIONAL CLOSURE VERSUS “FAR–FAR NEAR–NEAR” TECHNIQUE OF SINGLE-LAYER MASS CLOSURE AFTER EMERGENCY MIDLINE LAPAROTOMY

Abstract

Acute wound failure (wound dehiscence or burst abdomen) is a serious postoperative complication following emergency laparotomy, associated with significant morbidity, mortality, and increased healthcare costs. Various closure techniques have been evaluated to minimise this complication. The modified far–far near–near technique has been proposed to enhance fascial strength and reduce dehiscence. This study compares the outcomes of conventional continuous closure with the far–far near–near technique in emergency midline laparotomy wounds.

METHODS

A prospective randomized study was conducted from November 2015 to May 2017 at Bowring & Lady Curzon Hospital and Victoria Hospital thirty adult patients undergoing emergency midline laparotomy for conditions such as hollow viscus perforation, stab injuries, and blunt abdominal trauma were included. Patients were randomised into two groups: Group 1 –Conventional closure using continuous Prolene No.1, and Group 2 – Far–far near–near closure using interrupted sutures. Patients were followed for 6 weeks postoperatively to assess SSI (Surgical Site Infections), partial or complete wound dehiscence, and associated risk factors. Data were analysed using chi-square and t-tests.

RESULTS

The study population had a predominance of males (83.3%). The incidence of burst abdomen was 6.6%, occurring exclusively in the conventional closure group (2 cases), while no cases occurred in the far–far near–near group. SSI was observed in 36.6% of the total population. Risk factors such as anaemia, hypoproteinemia, peritoneal contamination, uraemia, diabetes, and postoperative cough were noted but showed no statistically significant difference between groups.

CONCLUSION

The far–far near–near interrupted technique demonstrated superior strength and significantly reduced the incidence of burst abdomen compared to conventional closure. It is a safe and effective method, particularly beneficial in high-risk emergency laparotomy patients.