A Comparative Study between Conventional Closure versus Modified Smead Jones Technique of Single-Layer Mass Closure with Polypropylene Suture after Midline Emergency Laparotomies

Abstract

Background: Failure of midline abdominal closure after emergency laparotomy remains an important cause of postoperative morbidity, particularly through wound infection, wound dehiscence, incisional hernia, and prolonged hospitalization.

Aim: To compare conventional continuous closure with modified Smead Jones single-layer mass closure using polypropylene suture after emergency midline laparotomy.

Materials and Methods: This ambispective comparative study included 116 adults who underwent emergency midline laparotomy, with 58 patients in each group. Group A underwent conventional closure and Group B underwent modified Smead Jones closure. Outcomes assessed were wound infection, wound dehiscence, incisional hernia, Southampton wound grade, and duration of hospital stay. Statistical analysis in the thesis used chi-square and independent t-test.

Results: Mean age was comparable between groups (46.98±16.88 years in Group A vs 45.22±16.87 years in Group B; p=0.5758). On postoperative day 3, wound infection was documented in 14 patients in Group A and 3 patients in Group B; the thesis summary table reported this difference as non-significant (p=0.7756). Wound dehiscence was significantly lower with modified Smead Jones closure (1.7% vs 15.5%; p=0.0206). Incisional hernia was less frequent in the modified group (5.2% vs 8.6%), although the difference was not significant (p=0.7141). Mean hospital stay was shorter in Group B (6.88±1.39 days) than in Group A (10.93±2.23 days).

Conclusion: Modified Smead Jones closure was associated with fewer postoperative wound complications overall, with the clearest statistical advantage seen for wound dehiscence and duration of hospital stay. Early wound infection and incisional hernia were numerically lower in the modified group.