A prospective study of assessment of prognostic factors in early and late wound dehiscence in midline vertical incision

Authors

  • Ramashankar Gupta Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Surendra Kumar Shrivastava Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Prateek Malpani Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • M. C. Songra Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203238

Keywords:

Burst abdomen, Laparotomy, Peritonitis, Postoperative day, Wound dehiscence

Abstract

Background: Wound dehiscence is separation of some or all layers of incision. It may be partial or complete. It is called as complete when all layers of the abdominal wall have been separated with or without evisceration of viscous. The study aims to find out and record the prognostic factors for wound dehiscence in vertical midline laparotomy.

Methods: This was a prospective study in 1400 laparotomies that developed wound dehiscence operated in Gandhi Medical College, Bhopal from august 2017 to august 2019. All the patients with burst abdomen operated during emergency or elective setting by midline vertical laparotomy were included.

Results: Wound dehiscence was most common in 51-60 years age group (26%). Majority patients were males (62%). Emergency laparotomy showed maximum incidence (71%). Bursts were seen mostly during 6th to 10th postoperative day. 78% patients presented as partial wound dehiscence and remaining as complete wound dehiscence. 46% presented as early wound dehiscence (7 days).

Conclusions: Post laparotomy wound dehiscence has multifactor etiology. Respiratory infections, anemia, and hypoproteinaemia are the contributing factors. Improper haemostasis during surgery and poor surgical technique are the predisposing factors.

Author Biographies

Surendra Kumar Shrivastava, Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

associate professor,department of general surgery,gandhi medical college,bhopal

Prateek Malpani, Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

associate professsor (mch urology)

M. C. Songra, Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Professor and head department of general surgery ,gandhi medical college,bhopal ,madhya pradesh,india

References

Maingot R: Management of the wound. Chap. 2, p. 29-50 in Abdominal Operations. Edited by R Maingot, New York: Appleton-Century-Crofts, Inc.; 1964.

Mayo CW, Lee MJ. Separation of abdominal wounds. AMA Arch Surg. 1951;62:883-94.

Rintoul RF. Farquharson’s Texbook of operative surgery. In: Rintoul RF, Johnstone JMS. Edt. Abdominal surgeries Access and procedures. 9th ed., Chapter 12, Churchill livingstone; 2005:201.

Afzal S, Bashir MM. Determinants of wound dehiscence in abdominal surgery in public sector hospital. Ann King Edward Med Univer. 2008;14(3):119.

Sivender A, Ilaiah M, Reddy GS. A Clinical study on risk factors causing abdominal wound dehiscence and management. J Dental Med Sci. 2015;14(10):18-23.

Lotfy W. Burst Abdomen: Is it a preventable complication. Egyptian J Surg. 2009;28(3):128-32.

Wong SY, Kingsnorth AN. Abdominal wound dehiscence and incisional hernia. Surg Int. 2002;57(6):100-3.

Poole GV. Mechanical factors in abdominal wound closure. The prevention of fascial dehiscence. Surg. 1985;97:631-9.

Pace A, Armitage NCM. Postoperative care. In: Williams NS, Bulstrode CJK, O’Connell PR, editors. Bailey and Love’s short practice of surgery. 25th ed. New York: Hodder Arnold; 2008:258-259.

Rodríguez-Hermosa JI, Codina-Cazador A, Ruiz B, Roig J, Gironés J, Pujadas M, et al. Risk factors for acute dehiscence of the abdominal wall after laparotomy in adults. Spanish Surg. 2005;77(5):280-6.

Wester C, Neumayer L, Smout RE. Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res. 2003;109(6):130-7.

Zochampuia R, Singh G, Rammuana K, Bhabatosh R, Lhuveto D, Singh R, et al. Clinical study of abdominal wound dehiscence in regional institute of medical sciences. Int J Current Res. 2016;8(1):25530-7.

Riou JP, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg. 1992;163:324-30.

Makela JT, Kiviniemi H, Juvonen T, Laitinen S. Factors influencing wound dehiscence after midline laparotomy. Am J Surg. 1995;170(9):387-90.

Carson JL, Noveck H, Berlin JA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfus. 2002; 42:812-8.

Spiliotis J, Tsiveriotis K, Datsis AD, Vaxevanidou A, Zacharis G, Giafis K, et al. Wound dehiscence: is still a problem in the 21th century: a retrospective study. World J Emerg Surg. 2009;4(1):12.

Graham DJ, Stevenson JT, McHenry CR, Lucas C, Smathers HM. The association of intra-abdominal infection and abdominal wound dehiscence/discussion. Am Surgeon. 1998;64(7):660-5.

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors Sabiston Text book of Surgery. 18th ed. Philadelphia: Elsevier Saunders; 2008:330-1.

Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for post laparotomy abdominal wound dehiscence. J Clin Diag Res. 2014;8(1):80.

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Published

2020-07-23

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Original Research Articles