?Cross-over? versus mass closure techniques for elective midline laparotomies

BACKGROUND: Midline incision (MLI) is the commonly used exploratory incision with an ongoing debate without consensus about the best way to close it. An ideal one closes the incision efficiently without early or late complications. So, we aimed in our study to evaluate the outcome of our new technique (cross-over technique) for closure of median laparotomy incision in comparison to the standard mass closure technique in elective cases. METHODS: Our study was carried out as a randomized clinical study in the department of general surgery, Menoufia University Hospitals & Delta specialized hospital from September 2017 to January 2020. One hundred and thirty-eight patients had elective midline laparotomies. Post-operative follows up for at least one year after surgery to detect either early complications as wound dehiscence or infection or late complications as incisional hernia. Patients were divided into two groups each, 69 patients' group (A) the cross over technique and group (B) the standard mass closure. RESULTS: This study included 138 patients 79 male and 59 female. Both groups were comparable regarding age, gender and indication for exploration. The reported incidence of wound dehiscence was (1.4%) and (11.6%) for both groups respectively with significant difference be-tween both groups(P=0.033). Incisional hernia was significantly higher in group (B) (10.7%) versus (1.4%) for group A (P=0.021) while wound infection showed no significant difference between both groups. CONCLUSIONS: Cross over technique for abdominal wall closure in elective laparotomies is an efficient and safe technique with possible reduction in post operative complications such as wound dehiscence and incisional hernia. However further studies with large scales and with inclusion of emergency cases are recommended for further evaluation and establishment.