Optimizing Abdominal Wound Healing: Mass Versus Layered Closure in Myomectomy Patients

Abstract

Background: Optimal abdominal wound closure remains a critical determinant of postoperative outcomes following gynecological surgery. Midline laparotomy closure techniques, particularly mass closure and layered closure, continue to be debated with respect to operative efficiency and postoperative complications. Aim of the Study was to: compare mass closure versus layered closure techniques for midline laparotomy wounds in women undergoing myomectomy, focusing on operative time and postoperative wound-related complications. Methods: This prospective comparative study included 100 women undergoing elective myomectomy via midline laparotomy. Participants were equally randomized into two groups: mass closure (n = 50) and layered closure (n = 50). Operative time for abdominal closure and postoperative complications—including wound infection, wound dehiscence, and suture sinus formation—were recorded and analyzed. Results: Mass closure significantly reduced the time required for abdominal closure compared with layered closure (p < 0.001). The incidence of wound dehiscence was significantly lower in the mass closure group (2%) than in the layered closure group (12%) (p = 0.049). Although wound infection rates were lower with mass closure (12% vs. 24%), this difference did not reach statistical significance (p = 0.11). The occurrence of suture sinus was low and comparable between groups. Conclusion: Mass closure of midline laparotomy wounds in myomectomy is a safe, efficient, and reliable technique associated with shorter operative time and reduced wound dehiscence compared with layered closure. These findings support the routine use of mass closure in gynecological abdominal surgery.