Assessment of Postoperative Complications Between Interrupted Modified Smead-Jones Rectus Closure and Conventional Rectus Closure in Midline Laparotomy Wounds: A Comparative Study

Introduction The abdomen comprises several layers that enhance its strength and flexibility, extending from the superficial to the deep layers of the anterior abdominal wall. Among these, the rectus sheath serves as a fibromuscular compartment essential for structural integrity, providing mechanical support and safeguarding the underlying tissues and organs. This study evaluates two midline closure techniques employed after midline laparotomy surgery to determine which technique offers superior strength and mechanical support. Materials and methods A single-center prospective comparative study was conducted over 18 months, from October 2022 to April 2024, at Sree Balaji Medical College & Hospital in Chennai, India. The study population comprised 92 outpatients and inpatients from the general surgery and emergency departments who underwent emergency and elective midline laparotomy surgery. Patients were selected using simple random sampling and categorized into two groups based on the type of rectus closure: conventional rectus closure (CRC) and interrupted modified Smead-Jones (IMSJ) rectus closure. Results In our study, approximately 34% (N = 31) of participants were aged 46-60 years, with a mean age of 53.45 ± 7.98 years. The sex distribution did not show significant preponderance. Complications included three cases of burst abdomen postoperatively, with 66.67% (N = 2) occurring in the CRC group. Incisional hernias were observed in six cases, with five belonging to the CRC group, indicating statistical significance. Additionally, wound infections were recorded in 10 cases, all within the CRC group. Out of 20 patients who developed localized collections, 32.6% (N = 15) were in the CRC group, while five belonged to the IMSJ group. Conclusions This study demonstrates that the IMSJ technique is superior to CRC in reducing postoperative complications. This advantage is attributed to its enhanced tensile strength and improved distribution of tension across the wound.