A twenty-year-old male patient presented in surgical emergency with history of blunt trauma to abdomen two weeks ago. The patient's only complaint was a vague abdominal pain after trauma, and he did not seek medical attention immediately.  After a week, he had severe abdominal pain, fever and loss of appetite and was treated in a local hospital. Later he was referred to our hospital.  He presented in our surgical emergency two weeks after the injury. On presentation patient was in shock with BP-80/60 mmHg, PR-120/min., temp-101. Abdomen was distended, tense and tender. On per rectal examination blood stained stools were present.  In x-rays, no air under diaphragm was seen and, in the ultrasound, only mild fluid collection in the pelvis was seen.

BACKGROUND There is a debate about the best method of closure of midline vertical laparotomy wound following exploratory laparotomy. Thi s debate has gained importance because one common complication of exploratory laparotomy is burst abdomen or abdominal wound dehiscence, which is associated with high morbidity, mortality and cost of care. There are a number of studies evaluating various closure techniques and suture materials. Studies carried out in the west have found no significant difference in the risk of burst between continuous and interrupted methods. The choice of closure methods may not be very crucial in patients undergoing elective laparotomy with adequate nutritional status and no other risk factors for bursts, unlike developing countries like ours where most patients present with one or more of risk factors such as malnutrition prolonged intra peritoneal sepsis. Hence it is imperative to ascertain the safest method of closing the laparotomy wound. We wanted to compare interrupted X method and professor Hughes far near technique, to identify the better method of closing midline laparotomy wound. METHODS This non-randomized controlled trial was done on patients admitted in the department of surgery, Government Medical College, Amritsar, from July 2016 to August 2018. 40 Patients taken up for midline laparotomy were divided into two groups with 20 in each group. Sample size was taken for convenience. In group-1 patients, interrupted-X technique with Vicryl was used for closing the sheath and in group-2 professor Hughes' far near technique with nylon was used. Intraoperative time taken, suture length, wound length, post-operative wound infection, wound dehiscence & burst abdomen ang suture sinus rates were assessed. RESULTS The operative time taken was lesser in group-2 patients in whom, Professor Hughes' far near technique was used. The suture to wound length ratio was more than 4:1 proven by Jenkins rule and the results were statistically significant. Wound infection, wound dehiscence and burst abdomen rates were less in group-2 patients than in group 1 patients but suture sinus rates were increased in group-2. CONCLUSIONS Professor Hughes technique with nylon is less time consuming with lesser wound infection, wound dehiscence and burst abdomen rates than interrupted-X method with Vicryl.