Continuous Versus Modified Continuous Smead-Jones Suture Techniques for Rectus Closure in Emergency Laparotomy: A Randomized Controlled Trial

Background: Emergency laparotomy is associated with a high incidence of postoperative fascial complications, including wound dehiscence and incisional hernia. The method of rectus sheath closure plays a crucial role in determining surgical outcomes. Continuous suturing is widely used due to its simplicity and speed, whereas the modified continuous Smead-Jones technique incorporates a far-near-near-far pattern that may improve tensile strength and fascial integrity. This study aimed to compare the efficacy and safety of continuous versus modified continuous Smead-Jones suture techniques for rectus sheath closure in emergency laparotomy. Methods: This randomized controlled trial included patients undergoing emergency midline laparotomy, who were randomly allocated into two groups. Group A underwent rectus sheath closure using the continuous suture technique, while Group B received the modified continuous Smead-Jones technique. Outcomes assessed included the incidence of wound dehiscence expressed as percentages, along with the duration of hospital stay, reported as (mean±standard deviation). Statistical analysis was performed using appropriate comparative tests, with p < 0.05 considered statistically significant. Results: The incidence of wound dehiscence was higher in Group A compared to Group B. The mean duration of hospital stay was longer in Group A (11.6 ± 3.8 days) than in Group B (9.2 ±2.9 days), with the difference being statistically significant (p = 0.001). Overall postoperative complication rates were lower in the modified continuous Smead-Jones group. Conclusion: The modified continuous Smead-Jones suture technique demonstrated superior outcomes compared to continuous suturing, with lower complication rates and shorter mean hospital stays. This technique may be preferred for rectus sheath closure in emergency laparotomy, particularly in high-risk patients.