Evaluation of abdominal wall closure technique in emergency laparotomies at a tertiary care hospital

Abstract

INTRODUCTIONExploratory laparotomy whether elective or emergency has always remained one of the common operations across the surgical disciplines. The closure of such a laparotomy wound is key to reduce the post-operative morbidity like wound pain, wound infections and incisional hernias.1 Wound dehiscence carries with it a substantial morbidity and mortality. Mortality associated with burst abdomen has been estimated at 16%.2 The mean time for wound dehiscence is 8-10 days after operation.2,3 Abdominal wound dehiscence is a common complication of emergency laparotomies in Indian setup.Wound dehiscence is related to technique of closure of abdomen. Many patients in India have poor nutritional status and the presentation of patients with peritonitis is often delayed. This makes the problem of wound dehiscence more common in Indian setup.4 Post-operative complete wound dehiscence is a very serious complication associated with high morbidity and mortality. 5 The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. To date, various randomised clinical trials and meta-analysis have been published with heterogeneous results. While the choice may not be so important in elective patients who are nutritionally ABSTRACT Background: Abdominal wound closure technique should be efficient to perform, provide strength and be a barrier to infection. The method of closure of the abdominal wall is a critical aspect of an effective incision closure, in addition to the choice of suture material. Abdominal wound dehiscence is a common complication of emergency laparotomy. This study was done to know whether our method of abdominal closure was helpful in reducing incidence of burst abdomen. Methods: This retrospective study was carried out in the department of general surgery in a tertiary medical centre in Mumbai. 126 Patients undergoing emergency laparotomies for extensive generalised peritonitis through a vertical midline incision were included in this study; the indications for laparotomy were inflammatory, traumatic and neoplastic. Results: Out of 126 patients undergoing closure of laparotomy wound by our method, wound infection was noted in 12 (9.52%) cases and 3 (2.38%) patients developed wound dehiscence (burst abdomen). Conclusions: This retrospective study demonstrates that our method of abdominal closure was helpful in reducing the incidence of burst abdomen post-operatively. This is of extreme clinical importance in reducing morbidity, mortality and healthcare cost related to abdominal wound dehiscence in a patient undergoing emergency laparotomy.

A study of post-operative complications of all emergency laparotomy in a tertiary care hospital within 90 days

“…These fi ndings were in concordance with the studies conducted by Kapoor et al, [6], in which 69% were between 21 to 50 year age groups where mostly the above aetiologies were found in this age group. Also the present study was similar to the study conducted by Gandhi et al, [9], where in 44.5% patients were Among the cases of perforation peritonitis, peptic perforation constitutes 50% cases followed by small bowel perforation (30%).The present study is similar to the study Gupta et al 7 (30.9%) , Jhoota et al, [10], (57%), Chauhan et al, [11], (31.42%), Graham et al, [12]. (29%), stating that peptic perforation is most common among all cases of perforation peritonitis.…”

Evaluation of a new technique for abdominal wall closure in midline laparotomies

“…The frequency of wound dehiscence after emergency laparotomy was 6.7% as compared to 1.5% in elective cases. 1 Rahman recorded abdominal wound dehiscence in 7 (23.23%) cases, among the 33 patients of spontaneous ileal perforations with acute peritonitis and an incidence of wound infection in 30.3 %. 14 Present study had 168 patients and there were 2 cases (1.2%) of wound dehiscence (who were managed by delayed direct suturing) on use of our new abdominal wound closure technique (Moharam Repair).…”

“…Burst abdomen was encountered in 10 -30 % of cases undergone midline laparotomy (MEL) especially in emergency cases. 1 Different mechanical reasons for wound dehiscence were encountered as (1) the suture breaks, (2) the knot slips, or (3) the suture cuts through the tissues.…”

“…The method of closure of such a laparotomy wound is the key to reduce the post-operative morbidity like wound infections, dehiscence and incisional hernias. 1 Mass closure remains the standard technique for abdominal closure (closing all layers of the abdominal wall, excluding the skin), with either non-absorbable or slow-resorbing sutures, such as polydioxanone (PDS). 2 The European Hernia Society Guidance on the closure of abdominal wall incisions (2015) recommended the use of prophylactic mesh augmentation for an elective midline laparotomy in a high-risk patient in order to reduce the risk of incisional hernia.…”

“…To date, various randomized clinical trials and meta-analysis have been published with heterogeneous results. 1 Healing of abdominal incisions is similar to healing of other wounds. The inflammatory phase lasts approximately 4 days, followed by the proliferative phase for 3 weeks.…”