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

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 complicationsConclusions: 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.

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“…Patients undergoing elective laparotomy usually have adequate nutritional status and fewer chances to develop dehiscence because of lower risk factors, compared to emergency patients with multiple risk factors [ 26 ]. 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 ].…”

“…Wound dehiscence is another post-laparotomy complication, 0.2-5% results from elective laparotomy, and up to 45% are associated with emergency laparotomy, leading to 30% incidence of mortality and morbidity [ 8 ]. Ideal closure of midline laparotomy incision is crucial to minimize the occurrence of incisional hernia and wound dehiscence, along with other frequently occurring post-operative complications like wound pain and surgical site infection (SSI) [ 9 ].…”

Penerapan Pemberian Terapi Musik Religi “Demi Masa” Untuk Penurunan Tingkat Kecemasan Pasien Pre Operasi Dengan Regional Anastesi Sub Arachnoid Blok Di Rumah Sakit K.R.M.T Wongsonegoro Semarang

“…Tercatat terjadinya insiden laparatomi disebagian besar kota di India sebanyak 10-30 % pembedahan perut dikaitkan dengan angka kematian hingga sebanyak 45 % . 2 Pada tahun 2018 tercatat dari bulan Januari hingga Desember 2018 terdapat kasus Apendicitis yang terjadi di RSUD K.R.M.T Wongsonegoro di Ruang Nakula 1 sebanyak 5,90 % Apendicitis. Pada bulan Januuari sampai April 2019 di Ruang Prabukresna sebanyak 12 kasus orang yang terkena Apendicitis.…”