DEEP TENSION SUTURES VERSUS INTERRUPTED FIGURE OF 8 SUTURES FOR CLOSURE OF THE RECTUS SHEATH IN TERMS OF WOUND DEHISCENCE IN COMPLICATED ABDOMINAL SURGERIES

Abstract

Background: Wound dehiscence remains a serious postoperative complication following abdominal surgery, contributing to increased morbidity, prolonged hospitalization, and higher healthcare costs. The risk is particularly elevated in emergency and contaminated surgical settings. Optimizing rectus sheath closure techniques may reduce the incidence of this complication. Objective: To compare deep tension sutures with interrupted figure-of-eight sutures for rectus sheath closure in terms of postoperative wound dehiscence in patients undergoing emergency abdominal surgery. Study Design: Randomized controlled trial. Setting: Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Gujrat. Duration of Study: Three months from 6^th March 2025 to 6^th June 2025. Methods: A total of 100 patients undergoing emergency exploratory laparotomy were randomly allocated into two groups: deep tension sutures (n = 50) and interrupted figure-of-eight sutures (n = 50) for rectus sheath closure. Postoperative assessment for fascial wound dehiscence was conducted clinically and ultrasonographically on postoperative days 3, 7, 10, 14, and 21. Data were analyzed using SPSS version 28. The chi-square test was applied to compare proportions, with statistical significance set at p ≤ 0.05. Results: Fascial wound dehiscence occurred in 6.0% of patients in the deep tension suture group compared with 26.0% in the figure-of-eight group (χ² = 7.44, p = 0.006). The mean defect size was significantly smaller in the deep tension group (0.7 ± 0.3 cm) than in the figure-of-eight group (1.9 ± 0.6 cm; p < 0.001). Post-stratification analysis demonstrated significantly lower dehiscence rates with deep tension sutures among high-risk subgroups, including patients with diabetes, hypertension, smoking history, and advanced age. Conclusion: Deep tension suturing significantly reduces both the incidence and severity of rectus sheath wound dehiscence compared with interrupted figure-of-eight sutures, particularly in high-risk emergency abdominal surgeries. This technique represents a simple, effective, and cost-efficient strategy for improving surgical outcomes in resource-limited settings.