Sutured and open clean- contaminated and contaminated laparotomy wounds at muhimbili national hospital: a comparison of complications.

A clinical trial was done to compare the complication rates in clean- contaminated and contaminated laparotomy wounds closed primarily and those left open in the surgical department, Muhimbili National Hospital from January 2001 to September 2001. The objectives of the study were to determine the proportion of patients exhibiting pus discharge or wound dehiscence within four weeks of laparotomy, to determine the duration of time patients require wound dressing following laparotomy, to determine the time required to declare the wound healed from the time of laparotomy, to determine the influence of wound complications on mortality, and finally to determine the proportion of patients developing incisional hernia within six months of laparotomy. In this study, all patients received Ceftriaxone Sodium (Powercef ®) as a prophylactic antibiotic at the time of induction of anaesthesia. The wound infection rate was 30.2% for those wounds left open compared to 2. 1 % for those wounds closed primarily. This difference is statistically vii significant (p=O.002). It required a longer duration of time for dressing those wounds left open compared to those closed primarily, the average being 16 days compared to 11 respectively (P=O.0002). There was no significant difference in the development of healing ridge, wound dehiscence, or incisional hernia between the two groups (p>O.05). There was no significant difference in the mean levels of haemoglobin and WBe count between the two groups (p>O.05). No death was related to wound complication. It was observed that the major complication from clean-contaminated \ and contaminated laparotomy wound is superficial wound infection with higher rate in open wounds compared to closed wounds. Open wounds require a longer period of dressing than closed wounds. It was difficult to conclude on the development of incisional hernia due to small number of patients who could be followed up to six months of laparotomy. viii It is recommended that clean- contaminated and contaminated laparotomy wounds be closed primarily if no gross spillage of visceral contents occurs during operation and a patient receives prophylactic antibiotics. Surgical wound dressings should not be changed unless there is evidence of infection or on the day of suture removal. Wound surveillance is required. Further studies are needed to determine the risk factors for open wounds to develop infection, to compare effectiveness of different types of antibiotics as well as elective against emergency operations.