Closure of Emergency Midline Laparotomy over Subcutaneous Closed Suction Drain to Mitigate Incisional Surgical Site Infection, Dehiscence and Hernia: A Prospective Comparative Study

Background: The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of the work wasto investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery. Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to January 2021  by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were randomized according to EML incision closure technique into group A without SCSD and group B with closure of EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia.Results: Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise, the duration of hospital stay was significantly shorter among patients in group B versus those in group A. Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of duodenal ulcer in group B. After a median follow-up of  26 (range: 7 - 44) months, the protective effect of SCSD against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during closure of non-traumatic EML.