Incidence and risk factors influencing morbidity and mortality in cases of burst abdomen after emergency and elective midline laparotomies

Authors

  • K. Viveka Vardhini Department of Surgery, Osmania General Hospital/Medical College Hyderabad, Telangana, India
  • D. Kishan Department of Surgery, Osmania General Hospital/Medical College Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184611

Keywords:

Burst abdomen, Evisceration, Midline laparotomy, Wound dehiscence, Wound disruption

Abstract

Background: Burst abdomen is a serious postoperative complication faced by surgeons and of greatest concern because of risk of evisceration, the need for immediate intervention and the possibility of repeat dehiscence. Wound dehiscence carries with it a substantial morbidity and mortality. In addition, there is an increase in the cost, increased hospital stays, nursing and manpower cost in managing its complications.

Methods: In this study a total 202 patients enrolled who underwent emergency and elective midline laparotomies. Patients clinically presenting as gaping of abdominal wound were included in study. Diagnosis was established by clinical examination. In all cases gentle probing of the wound with gloved finger done to confirm defect.

Results: In this study incidence of burst abdomen was seen in 80 patients (39.6%) and was common in patients who underwent emergency surgeries. Patients who had stoma construction had maximum number of burst abdomen. 150 (74%) cases underwent emergency laparotomies in which 64 (42%) cases developed burst abdomen. In 60 cases closure done with re-suturing of fascia and remaining cases by skin closure only due to sepsis, poor general condition of patients. Mortality was seen in (22.5%) patients due to postoperative complications

Conclusions: Burst abdomen is more common in emergency surgeries than elective surgeries. Wound infection and stoma construction increase the rate of burst abdomen. Mid-mid line incisions have increased incidence of wound dehiscence. Mortality is high despite early treatment due to complications.

References

Kulaylat MN, Dayton MT. Surgical complications. Sabiston text book of surgery. 19th edition. Saunders; 2012:283-284.

Keill RH, Keitzer WF, Nichols WK. Abdominal wound dehiscence. Ann Surg. 1973;106:573-7.

Bettman RB, Kobak MW. Relative frequency of evisceration after laparotomy in recent years. JAMA. 1960;172:1764.

Amini AQ, Khan NA, Ahmad J, Memon AS. Management of abdominal wound dehiscence: still a challenge. Pak J Surg. 2013;29(2):84-7.

Gabrie¨lle H, van Ramshorst, Nieuwenhuizen J, Hop WCJ, Arends P, Boom J, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg. 2010;34:20-7.

Meena K, Ali S, Chawla A, Aggarwal L, Suhani S, Kumar S, et al. A prospective study of factors influencing wound dehiscence after midline laparotomy. Surg Sci. 2013;4(8):354-8.

Carlson MA. Acute wound failure. Surg Clin North Am. 1997;77;607-36.

Mathur SK. Burst abdomen: A preventable complication, monolayer closure of the abdominal incision with monofilament nylon. J Postgrad Med. 1983;29.

Spiliotis J, Konstantino S, Tsiveriotis, Datsis AD, Archodaula, Georgios, et al. Wound dehiscence. World J Emerg Surg. 2009;4:12.

Jaiswal NK, Shekhar S. Study of burst abdomen; its causes and management. Int Surg J. 2018;5:1035-40.

Soni P, Haripriya VB, Haripriya A, Dutt V. Burst Abdomen; a postoperative morbidity. Int J Sci Study. 2015;3(6):175-8.

Tolstrup MB, Watt SK. Reduced rate of dehiscence after implementation of a standardized fascial closure technique in patients undergoing emergency laparotomy. Ann Surg. 2017;265(4):821-6.

Srivastava A, Roy S, Sahey KB. Prevention of burst abdominal wound by a new technique; a randomized trial comparing continuous versus interrupted X-suture. Indian J Surg. 2004;66(1).

Makela JT, Kiviniemi H, Juvonen T, Laitinen S, Finland O. Factors influencing wound dehiscence after midline laparotomy. Ame J Surg. 1995;170(4):387-90.

Wadstrom J, Gerdin B. Closure of abdominal wall: how and why? Clinical review. Acta Chir SC. 1990;156:75-32.

Sahlin S, Ahlberg J, Granstrlim L, LungstrGm K-G. Monofilament versus multifilament absorbable sutures for abdominal closure. Br J Surg. 1993;80:322-4.

Grantcharov TP, Rosenberg J. Vertical compared with transverse incision in abdominal surgery. Eur J Surg. 2001;167(4):260-7.

Bhat JG, Desai AD, Dave JP. A prospective study of 50 cases of abdominal wound dehiscence – etiology and its management. IJSR. 2017:2275-8.

Amer H, Mokhtar SM, Harb SE. Burst abdomen: should we change the concept, preliminary study. Egyptian J Surg. 2017;36:199-207.

Kapoor KK, Hassan MMN. A clinical study of abdominal wound dehiscence with emphasis on surgical management in Bangalore medical college and research institute. Int Surg J. 2017;4(1):134-40.

Pavlidis TE, Galatianos IN, Papaziogas BT, Lazaridis CN, Atmatzidis KS, Makris JG, et al. Complete dehiscence of the abdominal wound and incriminating factors. Eur J Surg. 2001;167:351-4.

Fischer L. Burst abdomen: clinical features and factors influencing mortality. Dan Med Bull. 1992;39:183-7.

Downloads

Published

2018-10-26

Issue

Section

Original Research Articles