Simple and safe technique for closure of midline abdominal wound dehiscence

Abo-Ryia, Mohammad Hamdy

doi:10.1007/s10029-017-1589-8

Cited by 4 publications

(9 citation statements)

References 17 publications

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“…The primary end point was the incidence of FD within 30 days postoperatively. Although there are several expressions for the same complication (eg FD, abdominal wound dehiscence, deep wound dehiscence, burst abdomen, evisceration, and acute postoperative wound failure), 2,6,9,11,12,[36][37][38][39][40][41][42] in this study, we adopted the term fascial dehiscence, which indicates the dehiscence that affected the fascia up to 30 days after the operation, with intact skin or disruption of all layers of the abdominal wall. FD detection was performed by careful examination of the abdominal wall by an experienced surgeon.…”

Section: Fdmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among highrisk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p ¼ 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p ¼ 0.05), seroma (19.0% versus 5.8%; p ¼ 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p ¼ 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

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Section: Fdmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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“…Nine studies reported the use of synthetic mesh, with a total of 241 patients [8, 10-12, 14, 17, 30]. The synthetic mesh was made of polypropylene in five studies, with a total of 142 patients [8][9][10][11][12]. Lord et al reported one patient treated with a Prolene ® mesh [31].…”

Section: Meshmentioning

confidence: 99%

“…Three of the 15 patients (20.0%) treated with synthetic mesh with VAWCM developed a recurrence [9]. In the group treated with synthetic mesh without VAWCM, no recurrence was reported (0/97 patients) [10][11][12]30].…”

Section: Meta-analysismentioning

confidence: 99%

“…The incidence of AWD ranges between 2% and 5.5% [1][2][3][4][5][6]. Mortality has been reported as high as 20.9% [7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…AWD usually occurs between the 6th and 12th postoperative day [12,[18][19][20]. It is associated with high costs prolonged hospital stay, repeat surgery and a frequent need for ambulatory wound care and follow-up visits [21].…”

Section: Introductionmentioning

confidence: 99%

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Management of abdominal wound dehiscence: update of the literature and meta-analysis

Denys

Monbailliu

Allaeys

et al. 2020

Hernia

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Purpose Abdominal wound dehiscence (AWD) is associated with significant morbidity and mortality. We aimed to provide a contemporary overview of management strategies for AWD. Methods PubMed, EMBASE, the Cochrane library and a clinical trials registry were searched from 2009 onwards using the key words "abdominal wound dehiscence", "fascial dehiscence" and "burst abdomen". Study outcomes included surgical site infection (SSI), recurrence, incisional hernia and 30-day mortality. Studies reported by the EHS clinical guidelines on AWD were included and compared with. OpenMetaAnalyst was used for meta-analysis to calculate statistical significance and odds ratios (OR). Results Nineteen studies were included reporting on a total of 632 patients: 16 retrospective studies, one early terminated randomized controlled trial, one review and the European Hernia Society guidelines. Nine studies reported use of synthetic mesh (n = 241), two of which used vacuum-assisted mesh-mediated fascial traction (VAWCM) (n = 19), six without VAWCM (n = 198) and one used synthetic mesh with both VAWCM (n = 6) and without VAWCM (n = 18); two used biological mesh (n = 19). Seven studies reported primary suture closure (n = 299). Three studies reported on an alternative method (n = 91). Follow-up ranged between 1 and 96 months. Meta-analysis was performed to compare the primary suture group with the synthetic mesh group. Heterogeneity was low to moderate depending on outcome. The overall SSI rate in the primary suture group was 27.6% versus 27.9% in the synthetic mesh group, resulting in mesh explantation in five patients; OR 0.65 (95% CI 0.23-1.81). Incisional hernia rates were 11.1% in the synthetic mesh group (19/171) and 30.7% in the primary suture group (67/218); OR 4.01 (95% CI 1.70-9.46). Recurrence rate did not show a statistically significant difference at 2.7% in the synthetic mesh group (3/112), compared to 10.2% in the primary suture group (21/206); OR 1.81 (95% CI 0.18-17.80). Mortality rates varied between 11.2% and 16.7% for primary suture group versus synthetic mesh; OR 1.85 (95% CI 0.91-3.76). Conclusion Included studies were of low to very low quality. The use of synthetic mesh results in a significantly lower rate of incisional hernia, whereas SSI rate was comparable to primary suture repair.

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Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy

Miholjcic,

Baud,

Iranmanesh

et al. 2023

Eur J Pediatr Surg

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Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. Methods Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. Results Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001). Conclusion This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.

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Simple and safe technique for closure of midline abdominal wound dehiscence

Abstract: This technique provides a simple, safe and effective alternative in the treatment of burst abdomen.

Cited by 4 publications

References 17 publications

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Management of abdominal wound dehiscence: update of the literature and meta-analysis

Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy

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