Comparison of Wound Outcomes Between Short-Stitch and Long-Stitch Fascial Closure Following Emergency Exploratory Laparotomy: A Prospective Comparative Study.

Background Emergency exploratory laparotomy is associated with a high incidence of postoperative wound complications, including surgical site infection (SSI) and surgical wound dehiscence (SWD). The fascial closure technique, particularly the stitch length and suture length-to-wound length (SL:WL) ratio, plays a crucial role in wound healing. While short-stitch (SS) techniques have demonstrated superiority in elective surgeries, evidence in emergency settings remains limited. Methods This prospective, observational, comparative study was conducted over 18 months at a tertiary care teaching hospital. Ninety-four patients undergoing emergency midline exploratory laparotomy were allocated into SS (n = 47) and long-stitch (LS; n = 47) groups using simple random allocation. Fascial closure was performed using continuous size 1-0 polydioxanone (PDS) suture. The same surgical team performed all procedures to minimize inter-operator variability. Outcomes assessed included SSI (Southampton grading), SWD (World Union of Wound Healing Societies (WUWHS) grading), time-to-fascial closure, postoperative pain (Visual Analogue Scale (VAS) scores), length of hospital stay, and the incidence of incisional hernia. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered significant.  Results Overall SSI incidence was significantly lower in the SS group compared to the LS group (10.6% (n = 5/47) vs 27.7% (n = 13/47); p = 0.036). Severe SSI grades were more frequent in the LS group but did not reach statistical significance. SWD incidence was also significantly lower with SS closure (12.8% (n = 6/47) vs 36.2% (n = 17/47); p = 0.016). Mean time-to-fascial closure was significantly longer in the SS group than in the LS group (14.8 ± 4.2 min vs 11.4 ± 2.9 min, p < 0.001). Postoperative pain scores and length of hospital stay did not differ significantly between groups. Conclusion SS fascial closure following emergency exploratory laparotomy is associated with significantly reduced SSI and wound dehiscence, with only a modest increase in closure time. Adoption of this technique may improve postoperative wound outcomes in emergency abdominal surgery.