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Abdominal Fascial Closure in Obstetrics: Comparison of Outcome Between Layer and Mass Closure *

EP Ezenkwele
UU Aniebue
CC Ezenyeaku


Background: Midline laparotomies are in common use in obstetrics for caesarean section and other obstetric laparotomies. Current challenges in this surgical approach include the best approach to the repair of the abdominal wall incision, the optimal suture material for its fascial repair and poor cosmetic outcome of the scar.
Objective: The study was to compare the outcome of layer and mass closure for midline abdominal incisions following caesarean section.
Methodology: A randomized prospective study was carried out at the Colliery Hospital Enugu between 2001 and 2006. One hundred and six consenting parturients were randomized into layer (52) and mass
closure (54) groups. Outcome measures were defined and the patients followed up at six weeks, 6 months and in the next pregnancy. Statistical analysis utilized Chi-square test and p-value of less than 0.05 was regarded as significant.
Results: The mean age of the parturients was 30.0 ± 5.1 years and the majority of parturients were multiparous (65%). The average duration of surgery was significantly shorter in mass closure than layer closure (43.1 vs 53.4 minutes; p <0.001). There was no statistically significant difference in the duration of hospitalization between the two groups. The incidence of wound sepsis was higher in the mass closure than layer group (5.5% vs 1.9%) but intra-abdominal and peritoneal adhesions were commoner
in the layer group. The only case of incisional hernia (1.5cm) was in the mass closure group.
Conclusion: Mass closure reduces operative time, exposure to anaesthesia and is cost effective. It is recommended as a relatively safe method of abdominal fascial closure in caesarean section.

Key Words: Abdominal Fascia, Suturing, Layered Closure, Mass Closure