Postoperative pain and wound complications in pediatric transverse laparotomy: mass closure versus layered closure-a randomized clinical trial

Monday A. Ituen; Emem I. Akpanudo; Catherine S. Eyo; Ekerete A. Ekot

doi:10.18203/2349-3291.ijcp20252211

Authors

Monday A. Ituen Department of Surgery, University of Uyo, Akwa-Ibom State, Nigeria https://orcid.org/0009-0007-0559-3895
Emem I. Akpanudo Department of Surgery, University of Uyo, Akwa-Ibom State, Nigeria https://orcid.org/0000-0001-9470-7274
Catherine S. Eyo Department of Anesthesia, University of Uyo, Akwa-Ibom State, Nigeria
Ekerete A. Ekot Department of Surgery, Addenbrookes Hospital, Hills road, Cambridge CB2 0QQ, United Kingdom

DOI:

https://doi.org/10.18203/2349-3291.ijcp20252211

Keywords:

Pediatric laparotomy, Abdominal closure, Wound complications, Mass closure, Layered closure, Abdominal surgery, Pediatric surgery, Nigeria

Abstract

Background: Optimal abdominal wall closure technique in pediatric laparotomy remains debated. This study compared wound complications and postoperative analgesia requirements following mass versus layered closure in children undergoing transverse laparotomy.

Methods: This single-center randomized clinical trial was conducted at the university of Uyo teaching hospital, (UUTH) Nigeria, between 2021 and 2023. Children aged ≤5 years who underwent laparotomy via a transverse abdominal incision were eligible. Excluded were previous laparotomy, abdominal wall defects, or contaminated or dirty wounds. Participants were randomly assigned to either mass or layered closure. In both groups, closure was performed using polyglactin 910 (Vicryl™) sutures by senior surgical trainees under standardized operative and postoperative protocols. Primary outcomes included surgical site infection (SSI), wound dehiscence, incisional hernia, and duration of postoperative analgesia. Follow-up lasted one year. Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests were used to compare outcomes between groups, with significance set at p<0.05.

Results: A total of 111 children were enrolled (56 mass closure; 55 layered closure). SSI was the most common complication, occurring in 11 patients (9.9%), followed by incisional hernia in 4 (3.6%) and wound dehiscence in 2 (1.8%). Wound dehiscence occurred only in the layered group (n=2, 3.6%), while incisional hernias occurred equally in both groups (n=2 each; 3.6%). Clean-contaminated wounds were significantly associated with SSI (p=0.024), but there were no statistically significant differences in complication rates or analgesia requirements between groups.

Conclusions: Both closure methods appear equally safe in paediatric transverse laparotomy when standard surgical technique is followed. Routine follow-up for at least one year is recommended to detect late complications.

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References

Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Library. 2017;2017(11):CD005661. DOI: https://doi.org/10.1002/14651858.CD005661.pub2

Rajaretnam N, Okoye E, Burns B. Laparotomy. StatPearls-NCBI Bookshelf. 2023.

Chukwubuike, KE, Laparotomy in Children in a Tertiary Hospital in a Developing Country: Indications, Complications and Outcome. Clin Surg J. 2022;5(2):34-40.

Abbas A, Laverde R, Yap A, Stephens CQ, Samad L, Seyi‐Olajide JO, et al. Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life-A Narrative Review. World J Surg. 2023;47(12):3419-28. DOI: https://doi.org/10.1007/s00268-023-07097-z

Lawal A, Akande M, Al-Mansur S, Shittu R, Akin-Adewale R, Tijani Y, et al. The evolution and impact of laparoscopic surgery in Africa: The Nigeria Perspective. Med J Zambia. 2025;52(1):77-86.

Partridge R, Sabharwal AJ. A8 transverse supraumbilical incision. In: Springer eBooks. 2013;37-9. DOI: https://doi.org/10.1007/978-3-642-20641-2_8

Chalya PL, Massinde AN, Kihunrwa A, Mabula JB. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Res Notes. 2015;8(1):218. DOI: https://doi.org/10.1186/s13104-015-1243-4

Van ’t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Brit J Surg. 2002;89(11):1350-6. DOI: https://doi.org/10.1046/j.1365-2168.2002.02258.x

Onyekwelu I, Yakkanti R, Protzer L, Pinkston CM, Tucker C, Seligson D. Surgical wound classification and surgical site infections in the orthopaedic patient. JAAOS Global Res Rev. 2017;1(3):e022. DOI: https://doi.org/10.5435/JAAOSGlobal-D-17-00022

Pocock SJ. Clinical Trials: A Practical Approach. John Wiley and Sons, Chichester. 1983.

Bande A, Saxena D, Nichkaode PB, Akhtar M A comparative study of single layer closure versus conventional layered closure of laparotomy wounds. Int Surg J. 2018;5(4):1459. DOI: https://doi.org/10.18203/2349-2902.isj20181130

Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med. 2020;29(3):365-74. DOI: https://doi.org/10.17219/acem/112600

Maruthi C, Katari A. A comparative study of the outcome of Mass Closure and Layered closure techniques for Midline Abdominal Incisions in a Teaching Hospital. J Med Sci Clin Res. 2019;7(10):255-61. DOI: https://doi.org/10.18535/jmscr/v7i10.44

Wante M, Gaudani R, Reddy V, Puvvada P, Mane P. Midline abdominal incision: mass closure and layered closure. J Chem Heal Risks. 2024;14(2):1225-9.

Hasan KM, Islam S, Huq M, Huque MM, Karim SM, Azam MS, et al. Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency Laparotomy in Children. J Biosci Med. 2020;08(08):180-93. DOI: https://doi.org/10.4236/jbm.2020.88016

Bhavikatti GS, Ghv RG. Comparative study of mass closure and layered closure techniques in midline and paramedian laparotomies. Acad J Surg. 2019;2(1):42-6. DOI: https://doi.org/10.21276/ajs.2019.2.1.12

Khan M, Akhtar N, Buzdar M. Comparison between mass closure and layered closure in major abdominal laparotomies. Pakistan J Med Health Sci. 2014;9(3):962-5.

Kumar R, Hastir A. Prospective clinical study: mass closure versus layer closure of abdominal wall. Int J Surg Med. 2017;3(4):228-33. DOI: https://doi.org/10.5455/ijsm.mass-closure-versus-layer-closure-abdominal-wall

Fernandez L. Abdominal closure technique: Midline laparotomy closure. Medscape. 2023.

Singh G, Ahluwalia R. A comparison between mass closure and layered closure of midline abdominal incisions. Med J Dr D Y Patil University. 2012;5(1):23. DOI: https://doi.org/10.4103/0975-2870.97505