Wound closure technique and acute wound complications in gastric surgery for morbid obesity: A prospective randomized trial

Background: During the past 10 years, numerous clinical studies have supported the use of continuous monofilament fascial closure after laparotomy. Because of the increased incidence of surgical-site infections and other acute wound complications in the morbidly obese, these patients are well suited for a study of technical factors that may affect the frequency of these wound complications. Study Design: A prospective, randomized study of the midline fascial, closure technique in gastric bariatric operations was conducted between 1991 and 1998 in 331 consecutive morbidly obese patients. At the time of closure of the upper midline laparotomy wound, the patients were randomized into two groups: Group I patients (n=172) underwent continuous fascial closure and group II patients (n=159) underwent interrupted fascial closure. All patients received prophylactic antibiotics in a similar fashion. Wounds were monitored for 30 days postoperatively, and acute wound complications were classified as superficial or deep. Superficial complications included superficial surgical-site infections, seromas, and hematomas. In all superficial complications, the fascia remained uninvolved and intact. Deep wound complications included deep surgical-site infections and fascial dehiscence. Results: A total of 49 acute wound complications occurred (15%), There were 22 superficial (7%) and 27 deep (8%) wound complications in the 331 in the patients studied. Group I patients experienced fewer total wound complications than group II patients (18 versus 31; p=0.021). Group I patients also experienced fewer deep wound complications than group II (5 versus 22; p = 0.003). Conclusions: Continuous fascial closure reduces major acute wound complications in morbidly obese patients undergoing gastric operations for obesity. (J Am Coil Surg 2000;191:238-243. (C) 2000 by the American College of Surgeons).