Abdominal wall dehiscence in emergency midline laparotomy: incidence and risk factors

Hegazy, Tarek Osama; Soliman, Salah S

doi:10.4103/ejs.ejs_7_20

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…Risk factors for abdominal fascial dehiscence have been studied in the past. As most important risk factors, surgical site infections [ 4 , 5 , 8 – 10 ], coughing or chronic lung disease [ 5 , 8 , 10 ] and hypoalbuminemia have been mentioned [ 9 , 10 ]. Other risk factors have been suggested but were significantly predominant in certain cohorts, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Other risk factors have been suggested but were significantly predominant in certain cohorts, i.e. chronic steroid use [ 4 , 5 ], diabetes mellitus [ 9 ] or hypertension [ 5 ]. Combining several common risk factors has been used to establish risk stratification scores for the preoperative risk assessment of BA development in the US [ 11 ] and the Netherlands [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

et al. 2021

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Background Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. Methods We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR. Results We included 504 patients in the analysis, 111 of those suffered from BA. We found intestinal resection (OR 172.510; 22.195–1340.796, p < 0.001), liver cirrhosis (OR 4.788; 2.034–11.269, p < 0.001) and emergency surgery (OR 1.658; 1.050–2.617; p = 0.03) as well as postoperative delirium (OR 5.058; 1.349–18.965, p = 0.016) as the main predictor for developing BA. The main reason for BA was superficial surgical site infection (40.7%). 110 patients received operative revision of the abdominal fascial dehiscence and 108 were eligible for BAR analysis with 14 cases of BAR. Again, post-operative delirium was the patient-related predictor for BAR (OR 13.73; 95% CI 1.812–104-023, p = 0.011). The surgical technique of using interrupted sutures opposed to continuous sutures showed a preventive effect on BAR (OR 0.143, 95% CI 0.026–0,784, p = 0.025). The implantation of an absorbable IPOM mesh did not reduce BAR, but it did reduce the necessity of BAR revision significantly. Conclusion The use of interrupted sutures together with the implantation of an intraabdominal mesh in burst abdomen repair helps to reduce BAR and the need for additional revision surgeries.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

et al. 2021

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“…The overall rate was 18.5%. Hegazy et al, in their paper published in 2020 on burst abdomen in emergency midline laparotomy cases, noted a higher rate of 12.4% who concluded that wound infections as the most common risk factor for its development (46). Similarly, another prospective study was done on 50 wound dehiscence by Ramneesh et al…”

Section: Discussionmentioning

confidence: 97%

Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial

Singh,

Sethi,

Mishra

et al. 2023

Langenbecks Arch Surg

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“…Incidence of post-laparotomy wound dehiscence is reported as 0.2-5% in elective surgeries and 45% in emergency surgeries; in developing countries, the rate is 30% after undergoing laparotomy for various reasons [ 8 ]. A prospective cohort study recorded 12.4% incidence of burst abdomen or wound dehiscence after emergency midline laparotomy [ 27 ]. A previous randomized controlled trial observed 12.5% cases of wound dehiscence within one month of emergency midline laparotomy.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Controlled Trial Comparing Clinical Equivalence of PD Synth and PDS Polydioxanone Sutures

Prabha Shankar,

Mathew,

Tippana

et al. 2023

Cureus

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Introduction Incisional hernia is a common complication of midline laparotomy that may develop even after several years of surgery. Abdominal fascia closure with ideal suture material reduces the incidence of incisional hernia. This study compared the clinical equivalence of PD Synth (Healthium Medtech Limited) and PDS (Ethicon, Johnson & Johnson) slowly absorbed polydioxanone suture with respect to the occurrence of incisional hernia, following elective/emergency midline laparotomy. Methods Eighty-eight subjects undergoing elective/emergency midline laparotomy were randomized to PD Synth (n=45) and PDS (n=43) groups of this prospective, multicenter, randomized (1:1), single-blind, two-arm, parallel-group study (December 2020-May 2023). Primary endpoint was incidence of incisional hernia, occurring within six and 12 months of surgery. Secondary endpoints included incidence of fascial dehiscence, surgical site infection (SSI), suture sinus, seroma, hematoma, scar tenderness, and re-suturing, and evaluation of operative data, hospital stay, intra-operative suture handling, pain, time to return to normal day-to-day activities and work, overall patient satisfaction score, and adverse events. Results One subject in both PD Synth and PDS groups (p>0.05) developed incisional hernia at umbilicus 12 months post-laparotomy. In PDS group, one subject each had incidences of SSI on day 2, day 7, and one month, two subjects developed seroma on day seven, and one subject had readmission on one month; two subjects in PD Synth group developed superficial SSI (one month). Findings of other secondary endpoints were comparable between the groups. Conclusion Primary and secondary outcomes manifested that PD Synth and PDS slowly absorbed polydioxanone sutures are clinically equivalent, and can be used for abdominal fascial closure following midline laparotomy.

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Abdominal wall dehiscence in emergency midline laparotomy: incidence and risk factors

Cited by 7 publications

References 4 publications

Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial

A Prospective Randomized Controlled Trial Comparing Clinical Equivalence of PD Synth and PDS Polydioxanone Sutures

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