Mir Arsalan Ali, Batool Zehra Asjad, Sughra Perveen, Zakia Nehal, Bushra Kiran Rajput.
Primary closure versus delayed primary closure in perforated appendix: a comparative study.
Pak J Surg Jan ;35(2):94-7.

Introduction: Primary closure has the potential benefit of rapid wound healing associated with the elimination of painful and time-consuming dressing changes, as well as a reduction in overall hospital costs. Although controversy persisted concerning the optimal methods of wound management, recent studies tend to recommend that perforated appendicitis most oft en can be primarily closed without an increase in the wound infection rate as compared to delayed primary closure. Objective: To compare the primary closure verses delayed primary closure in patients with perforated appendix Study design: Randomized controlled trial Sett ing: Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi Duration of study: 1 year from January 27, 2016 to January 26, 2017 Material and Methods: All patients aged 18-45 years of either gender having perforated appendix undergoing appendectomy were enrolled. Appendectomy was performed in the conventional manner and the appendicular stump was not invaginated in any of the cases. Muscles was approximated with interrupted 2/0 vicryl. External oblique was closed by continuous suture using vicryl 0 in PC group. Th e wound was thoroughly cleansed with normal saline only. In patients undergoing delayed primary closure, daily dressing was changed and in case of the presence of infection it was changed twice daily when required, till the closure of the wound. Wound was closed aft er refreshing the edges aft er 3rd post-operative days or once the infection was sett led in cases of infected wounds. Final outcome was assessed on 7th post-operative day in terms of wound infection and duration of hospital stay as per operational definition. Results: Mean age of the patients was 37.36+-10.49 years. Mean duration of hospital stay was 7.38+-1.25 days. Th ere were 37(61.70%) females and 23(38.30%) males. Wound infection was found in 13(21.70%) patients. 11 patients in Group-A (primary closure group) developed wound infection as compare to 2-patients in Group-B (delayed primnary closure). Statistically significant difference was found in the comparison of wound infection with group B to A p-value 0.005. Regarding duration of stay in hospital, the duration with group-A 6.24 +- 0.47 to group-B 8.53+-0.51 p-value 0.001. Conclusion: There is a significant difference in primary closure verses delayed primary closure in patients with perforated appendix

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