The influence of suture pattern on the incidence of incisional drainage following exploratory laparotomy

Reasons for performing study Incisional complications following exploratory celiotomy increase morbidity, extend hospitalisation and increase cost. Retrospective studies seek to identify risk factors and measures for prevention of surgical site infection. The relatively high incidence of incisional complications following exploratory laparotomy necessitates identification of ideal surgical closure methods. Objectives The study sought to identify the incidence of incisional drainage within our hospital population, and to identify risk factors for incisional complications while determining surgical practices that reduce the incidence of incisional drainage. Study design Retrospective cohort study. Methods A retrospective study, with telephone follow-up, was performed on 199 horses that underwent exploratory laparotomy at the University of Georgia from 2 January 2008 to 31 December 2010, examining associations between case background, lesion type, access to the lumen of the bowel, and closure methods and incisional draining. The linea alba incisions were closed by the primary surgeon and junior house officers closed the subcutaneous tissues and skin. Results The incidence of purulent or persistent serosanguinous incisional drainage in 142 horses with complete follow-up information was 21.8%. Background, lesion type, and enterotomy or enterectomy were not associated with a significantly increased likelihood of incisional drainage. However, closure of the subcutaneous tissues and skin in a 2-layer, modified subcuticular pattern was associated with a significantly lower incidence of post operative incisional drainage. Follow-up information identified subsequent episodes of colic in 28.9% of horses. However, 80.3% of horses had returned to their previous level of work. Conclusions and potential relevance Incisional drainage is common following ventral midline laparotomy. The use of a 2-layer, modified subcuticular closure was associated with a significant reduction in the incidence of incisional drainage compared with closure performed with skin sutures, but not closure performed with staples. The Summary is available in Chinese - see Supporting information.