INTRODUCTIONA midline incision is the most commonly used access route for emergency laparotomy as it is simple, quick, bloodless, has best extensibility and provides excellent exposure.1,2 But it's drawbacks are comparatively increased incidence of postoperative wound dehiscence and an incisional hernia compared to other incisions. 3Many factors influence wound complications like wound sepsis and dehiscence. Some of the patient related factors are their nutritional status, hypoalbuminaemia, anaemia, immunosuppressed states, renal failure, uncontrolled diabetes, malignancies, steroid therapy and obesity. Other set of factors which influence the strength of repair and healing are related to the technique of suturing. Some of them are the size and type of suture material used (monofilament versus polyfilament, absorbable vs. nonabsorbable, natural versuss synthetic) and also the ABSTRACT Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure. Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test. Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p >0.05). Wound dehiscence rate was significantly less in the study group (p < 0.05) compared to control group. Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.

Because of the great efficacy of multidrug therapy (MDT), it had been hoped that the widespread use of MDT would bring about a rapid decrease of the incidence of leprosy. To the present, a decrease of incidence has not been observed, possibly because of the long incubation period of the disease, and because general implementation of MDT is still recent. Other reasons, such as environmental sources of infection or the role of healthy carriers in transmitting Mycobacterium lepr ae, cannot be excluded. Therefore, one must seek alternative or supplementary strategies, such as chemoprophylaxis. Household contacts of leprosy patients are at greater risk of developing leprosy than is the general population. Therefore, a randomized, controlled trial of chemoprophylaxis, using a single 10 mglkg dose of rifampicin, or a placebo, is planned in nine proj ects in India, among the household contacts of newly detected leprosy patients. Based upon assumptions of a protective efficacy of the chemoprophylaxis of 50%, an annual incidence of 2 per 1000 contacts, a desired power of the study of 90%, and a level of significance of 95%, 15,000 household contacts will be allocated randomly by household to each arm of the study, and followed for 5 years. Considered as household contacts will be all persons living in the same household as an index case and sharing the same kitchen. Pregnant women and infants will be excluded. To be certain that transmission of the organisms from the index case cannot occur once the prophylaxis is administered, rifampicin will be administered 2 months after diagnosis of the index case. Diagnosis of leprosy will be clinical, and confirmed independently. Although household contacts usually consti tute only a small proportion of the new patients detected in a control programme, their high-risk status makes them particularly appropriate for a study of the potential effect of chemoprophylaxis. Following the trial, one could evaluate the usefulness and feasibility of using the same strategy in other popUlation-groups, based on the number of persons necessary to treat to prevent one case.

Aim Extended total mesorectal excision (eTME) is a complex procedure involving en bloc resection of the structures surrounding the various quadrants of the rectum. This study, presenting the largest series so far of patients undergoing eTME, aimed to assess the surgical and survival outcomes of patients following treatment with eTME and to compare these outcomes with historical data on pelvic exenteration. Method The study is a retrospective review of all patients with locally advanced rectal cancer requiring an eTME (2014–2020). The database includes the demographic profile, operative details, histopathological features and follow‐up. Results One hundred and sixty three patients who underwent eTME were analysed. The overall Clavien–Dindo complication rate of > IIIa was 21.1%. The anterior quadrant was the most common anatomical site resected (68.5%). The R1 resection rate was 10.4%. After a median follow‐up of 28 months, there were 51 recurrences in the study and twenty two deaths were recorded. The local recurrence rate was 7.3% among the study population. The disease‐free survival (DFS) and overall survival were 66.7% and 80.4%, respectively, at 3 years. The majority of the recurrences were distant metastasis (84.3%). In univariate analysis, the quadrant involved did not affect survival. In multivariate analysis, signet ring histology, metastatic presentation, inadequate tumour response and R1 resection affected DFS. Conclusion The recurrence pattern, R1 resection rate and survival outcomes of patients in the present study were comparable with those for patients undergoing an exenteration. Therefore, eTME is probably a safe alternative to pelvic exenterations when R0 resection is achievable and when the procedure is performed in high‐volume specialist tertiary care centres.

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