An abdominal wound dehiscence of emergency explorative laparotomy and their management at tertiary care centre: an observational study
Keywords:Abdominal wound dehiscence, Exploratory laparotomy, Tertiary care hospital
Background: Wound dehiscence is a very troublesome sequel of impaired wound healing. Despite of medical advances frequency of wound dehiscence in emergency laparotomy remains high due to multiple factors together predisposes. Better understanding of common mechanisms and highly contributing factors will help to keep high risk patients under strict surveillance to reduce the incidence of wound dehiscence.
Methods: The observational study was carried out in 167 patients of above 14 years age at the department of General surgery, SMIMER hospital, Surat between November 2018 to October 2020
Result: 22.15% patients developed wound dehiscence, mean age in dehiscence group was 39.27±9.65 years. Abdominal pain was found in all the patients 100% followed by vomiting 28.74% and fever 13.17%. However, Fever (2.37±1.95 days vs 1.55±1.78 days) and Abdominal distention (1.05±1.06 days vs 0.47±0.87) have statistical significance between Wound Dehiscence and No Wound Dehiscence regarding chief complaints. As a treatment of wound dehiscence, 2 (5.40%) had Re-exploration and 6 (16.21%) had Re-exploration and Tension Suturing in complete wound dehiscence patient group and 29 (78.39%) had Secondary suturing found in partial wound dehiscence. 5.40% of mortality found in Wound Dehiscence group.
Conclusions: Significant risk factors for abdominal wound dehiscence identified in this study are presenting complains like fever and abdominal distension, pre-operative hypoalbuminemia, pre-operative anemia, leucocytosis, renal dysfunction, intra-abdominal sepsis. Use of subcutaneous negative tube is protective for the condition. Hollow viscus perforation patients showed higher vulnerability for wound dehiscence.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery. USA: Elsevier Health Sciences; 2016.
Jones V, Bale S, Harding K. Acute and chronic wounds. Wound care essentials: Practice principles. Philadelphia: Lippincott, Williams & Wilkins; 2004.
Greenall MJ, Evans M, Pollock AV. Midline or transverse laparotomy? A random controlled clinical trial. Br J Surg. 1980;67:188-90.
Afzal S, Bashir MM. Determinants of wound dehiscence in abdominal surgery in public sector hospital. Ann King Edward Med Univ. 2008;14(3):110-5.
Talukdar M, Gopalarathnam S, Paul R, Shaan AR. Clinical study on factors influencing wound dehiscence in emergency exploratory laparotomy. J Evol Med Dental Sci. 2016;5(34):1934-9.
Hegazy TO, Soliman SS. Abdominal wall dehiscence in emergency midline laparotomy: incidence and risk factors. Egypt J Surg. 2020;39(2):489.
Hanif N, Ijaz A, Niazi UF. Acute wound failure in emergency and elective laparotomies. J Coll Physicians Surg Pak. 2000;11:23-6.
Muneiah NS, Kumar NM, Sabitha P, Prakash DG. Abdominal wound dehiscence-A look into the risk factors. IOSR J Dent Med Sci. 2015;14(10):47-54.
Nancharaiah P, T.Prasad T, Venkateswarulu MC. A clinical study of abdominal wound dehiscence and its management. J Dent Med Sci. 2018;17(2):49-54.
Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for post laparotomy abdominal wound dehiscence. Journal of clinical and diagnostic research. JCDR. 2014;8(1):80.
Kapoor KK, Hassan MMN. A clinical study of abdominal wound dehiscence with emphasis on surgical management in Bangalore medical college and research institute, Karnataka, India. Int Surg J. 2017;4:134-40.
Carson JL, Duff A, Poses RM. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055-60.
Mary CF, Chudar A, Karthikeyan R. A clinical study of abdominal wound dehiscence and management. J Evid Based Med Healthcare. 2019;6(32):2171-5.
White H, Cook J, Ward M. Abdominal wound dehiscence. A 10 year survey from a district general hospital. Ann R Coll Surg Engl. 1977;59(4):337-41.
Hemant Borse and Rahul Shelke Study of Various Organisms associated with Surgical Site Infection and their Sensitivity Pattern. MVP J Med Sci. 2015;2(2):118-23.
Talukdar M, Gopalarathnam S, Paul R, Shaan AR. Clinical study on factors influencing wound dehiscence in emergency exploratory laparotomy. J evolv Med Dent Sci. 2016;5(34):1934-9.
Vishwanath P, Aboosalih S, Balaji D, Prabu KRM. The role of subcutaneous negative suction drains in exploratory laparotomy for peritonitis. Int J Sci Res. 2019;8(11):34-9.