Burst Abdomen: A Preventable Complication in Gynecological Oncology

Abstract

To determine whether burst abdomen can be prevented in gynecological malignancies by layered closure of the abdomen and by the routine use of Ryle’s tube, abdominal and subcutaneous drains. A total of 43 patients underwent surgery through a midline vertical incision over a period of 10 months between January 01, 2015 and October 31, 2015. All incisions were closed by mass closure technique. No drains were used in any of the patients. Subcutaneous fat was approximated with interrupted sutures in patients who had a subcutaneous fat thickness of more than 2 cm. Skin was closed by mattress sutures. All patients were started on oral sips once bowel sounds were heard. Ryle’s tube was inserted postoperatively only if the patient developed distention. During the next 10 months, between November 01, 2015 and August 31, 2016, a total of 36 patients underwent surgery through a right paramedian incision. The abdominal closure was done by closing the peritoneum and rectus sheath separately. An abdominal drain and a subcutaneous drain were placed in all patients. In very thin patients with little subcutaneous fat, a mini suction drain was placed. No sutures were taken on subcutaneous fat even in morbidly obese patients. Skin was closed using staplers. Ryle’s tube was inserted in all patients during induction and was removed only after patients passed flatus. Oral sips were started only after the patient passed flatus. There were 3 cases of burst abdomen in the first group (6.9%). There were 4 full-length wound gapes and 3 partial wound gapes in the first group (16.2%). In the second group, there was just one case of burst abdomen (2.7%), one case of full-length wound gape (2.7%), and 1 case of stitch sinus (2.7%). Layered closure of the abdomen and routine placement of Ryle’s tube, abdominal and subcutaneous drain, resulted in reduction in incidence of burst abdomen from 6.9 to 2.7% and incidence of wound gape from 16.3 to 2.7%. However, the most important factor in prevention of burst abdomen is control of predisposing factors. We still had one patient who had burst abdomen because of uncontrolled cough.