A Prospective Comparative study of Conventional Abdominal Closure with Hughes Abdominal Repair to Prevent Burst Abdomen and Incisional Hernia in Midline Laparotomy Emergency Abdominal Surgeries

BACKGROUND: The incidence of incisional hernias varies between open surgeries and laparoscopic surgeries. A number of studies have been done to ascertain the best method of closing the abdominal wall; however, it is still inconclusive. There are studies that suggest that non absorbable sutures reduce the risk of recurrence and incisional hernia incidence. AIM AND OBJECTIVE: This study aimed to compare the efficacy of Hughes Abdominal repair with conventional abdominal closure in midline emergency abdominal surgeries and to reduce the incidence of Incisional Hernias. MATERIAL AND METHODS: A Prospective Comparative study was done among 100 patients planned for emergency Laparotomy each 50 divided non-randomly in to two groups from November 2018 to December 2020. The 50 cases of emergency laparotomy were chosen non randomly and allocated for Hughes Abdominal Repair. The 50 cases of emergency / elective laparotomy were chosen non randomly and allocated for conventional repair. All patients were discharged after suture removal on 10th post-operative day and 15th post-operative day and monthly follow up to 1 year. Both groups are followed monthly for a period of one year and the after second year and incidence of incisional hernia in both groups documented and tabulated. CT abdomen taken at one year and at second year and any defect was documented. All data were recorded in structured questionnaires, coded and entered in Microsoft Excel. The data was analysed using SPSS v23. Student’s t-test was used for comparison. RESULTS AND CONCLUSIONS: The mean age of the participants in Hughes repair group is 54.02 years with a standard deviation of 8.9 years. The mean age of the participants in conventional repair group is 56 years with a standard deviation of 12.1 years. Among all the cases, majority of them were males (n=77, 77%). Rest of them were females (n=23, 23%). In the Hughes repair group, majority of them have hollow viscous perforation (n=10, 20%). In the conventional repair group, majority of them have hollow viscous perforation (n=10, 20%). The mean duration of hospital stay in Hughes repair is 10. 5 days (S.D=2.09 days). The mean duration of hospital stay in conventional repair is 11. 3 days (S.D=3.02 days). Chi-square analysis of wound complications shows that the incidence of complications are higher in the Conventional repair group that is statistically significant (p<0.05). Chi-square analysis of overall complications shows that the incidence of complications are higher in the Conventional repair group that is statistically significant (p<0.05). Hughes Repair (n=1): Only one incisional hernia was noted first in 11th month. Conventional Repair (n=4): Incisional hernias were noted in 6th, 8th, 9th and 12th month CT scan. In the first year; Hughes Repair (n=1): Only one defect was found but in Conventional Repair (n=3): three defects were found Chi-square analysis of wound defects shows that the incidence of defects are higher in the Conventional repair group that is statistically significant (p