Incidence Of Burst Abdomen Research Articles

The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study

PurposeThe emergency midline laparotomy is a commonly performed procedure with a burst abdomen being a critical surgical complication requiring further emergency surgery. This study aimed to investigate the clinical outcomes of patients with burst abdomen after emergency midline laparotomy.MethodsA single-center, prospective, observational cohort study of patients undergoing emergency midline laparotomy during a two-year period was done. Abdominal wall closure followed a standardized technique using monofilament, slowly absorbable suture in a continuous suturing technique with a suture-to-wound ratio of at least 4:1. Treatment of burst abdomen was surgical. Data, including intra-hospital postoperative complications, were collected and registered chronologically based on journal entries. The primary outcome was to describe postoperative complications, length of stay, and the overall morbidity based on the Comprehensive Complication Index (CCI), stratified between patients who did and did not suffer from a burst abdomen during admission.ResultsA total of 543 patients were included in the final cohort, including 24 patients with burst abdomen during admission. The incidence of burst abdomen after emergency midline laparotomy was 4.4%. Patients with a burst abdomen had a higher total amount of complications per patient (median of 3, IQR 1.3–5.8 vs. median of 1, IQR 0.0–3.0; p = 0.001) and a significantly higher CCI (median of 53.0, IQR 40.3–94.8 vs. median of 21.0, IQR 0.0–42.0; p = < 0.001).ConclusionPatients with burst abdomen had an increased risk of postoperative complications during admission as well as a longer and more complicated admission with multiple non-surgical complications.

PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

Background :Burst abdomen is a major complication associated with contaminated or dirty surgeries, including emergency midline laparotomy. Possible causative factors involve wound sepsis, patients’ overall pressure inside the abdomen, and many system problems. Conventional oncosurgical approaches could prove inadequate, leading to evaluation of preventive methods, such as DTS, of minimizing such adverse outcomes. Objectives :To evaluate the level of success of deep tension suturing done before the primary closure of the abdomen against formation of burst abdomen, wound infection, and incisional hernia than mass closure techniques. Study design: A Cross sectional study. Place and duration of study. This Cross Sectional study was carried out at Setting: Done at Ziauddin Hospital, Civil Hospital- ward 06, and PAF Hospital, Karachi from Change the dates in duration of study as follows: January 2019 to Jan 2022 Methods: A Cross Sectional study which involved 100 adults who were posted for emergency midline laparotomy due to generalized peritonitis. Patients were divided into two groups: Group A: conventional mass closure Group B: closure with DTS. Both groups received simple polypropylene sutures for wound closure as in the standard mesh repair technique but not in group B they also received four deep tension sutures using the rubber tubing to distribute tension over wider areas of the tissue. Patients with diabetes, immunosuppression, or use of corticosteroids were excluded as a result. Results The age in years of the participants was 31.61 ± 9.31 years; the maximum age was 61 years, the minimum was 18 years. The observation was made that the incidence of burst abdomen in Group B was 4 and that of Group A was 18 (p&lt;0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p&lt;0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p&lt;0.05. These outcomes show decreases in all of the primary complications when implementing DTS on the approaches as there were statistically significant improvements for all of them. Conclusion :The pro-active use of deep tension sutures in emergency midline laparotomy dramatically decreases the rate of burst abdomen, wound infection, and incisional hernia. As tension on the wound edges is reduced by DTS, the study shows that postoperative complications are preventable in high-risk surgeries, patient benefits maximized, and reoperations minimized.

BURST ABDOMEN: RELATED FACTORS AND POST-OPERATIVE CHALLENGE FOR SURGEONS

ABSTRACT Background: Burst abdomen is a post-operative dehiscence of the layers of abdominal wall including peritoneum with exposure of the intestines and is one of the most frustrating and difficult. Type of incision vertical or transverse, nature of surgery elective or emergency and postoperative complications affect the outcome of Laparotomy. Objective: To find and evaluate effective management of abdominal wound dehiscence in elective and emergency Laparotomy and how to prevent and overcome its complications. This post-operative complication encountered by surgeon is always a challenge. The main concern is because of risk of evisceration and need to intervene and there is always a possibility of recurrence of dehiscence. Patients and Methods: Our study was conducted in 310 patients who had undergone exploratory laparotomy at Punjab Institute of Medical Sciences, Jalandhar, Punjab, India . Out of 310 patients, 170 patients underwent emergency laparotomy and 140 were elective cases. They were managed either by midline vertical incision or transverse incision and outcome of results were analyzed for wound dehiscence. Result: Most significant variation associated with wound dehiscence was with hypoproteinemia, anemia, chronic cough and emergency procedures. Pre-operative and post-operative etiological factors such as chronic cough, anemia, hypoproteinemia, diabetes, obesity, use of Steroids, wound infection, abdominal distension, bowel leaks, electrolyte imbalances are significantly responsible for the outcome of patients. Moreover, the hospital stay was too long in burst abdomen and this adds to the economic burden on patient. 3 patients developed incisional hernia which was managed after 6-8 months by Mesh Hernioplasty. Conclusion: Midline Vertical incision is always the reason of choice in condition where quick access to intra-abdominal entry is required but transverse incision is a good access to intra-abdominal approach and the incidence of burst abdomen is less. Proper single or mass closure technique should be adopted and every effort should be made to minimize both pre-operative and post-operative risk factors.

O03 SMALL BITES AND PROPHYLACTIC MESH TO PREVENT INCISIONAL HERNIA IN HIGH-RISK PATIENTS. A MESH IS THE MOST POWERFUL TOOL

Abstract Aim Small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by guidelines to prevent incisional hernias (IHs) and burst abdomen (BA). Our aim was to implement a protocol combining both and to analyze its outcomes. Material and Methods Prospective data collection of all EMLs for one year. Results were analyzed at one month and during follow-up. The incidence of IH and BA was compared by groups depending on the use of a PM (M Group) or not (S Group), and in subgroups related to the closure technique: SB (Subgroups MSB and SSB) or not (Subgroups MLB and MSB). Results A lower number of BA was diagnosed in the M group (OR 0.0692; CI95% 0.008-0.56; P = 0.01) in 197 operations. 163 patients completed a mean follow-up of 29.23 months, with a lower frequency of IH in M group patients (OR = 0.769; CI 95% 0.65 - 0.91; P &amp;lt; 0.0001). Same differences persisted after a propensity matching score: BA (OR = 0.355; CI 95% 0.255 - 0.494; P &amp;lt; 0.0001) and IH (OR = 0.394; CI 95% 0.24 - 0.61; P &amp;lt; 0.0001). Comparing suturing techniques by subgroups any difference in IH and BA appeared. PM was the main factor related to reduction of IH (HR 11.794; CI 95% 4.29 - 32.39; P &amp;lt; 0.0001). Conclusions A PM is the most powerful tool for prevention both IH and BA after EMLs, regardless of the closure technique in patients at high-risk for IHs.

A Comparative Study Using Interrupted Figure of Eight Suture Versus Conventional Continuous Suturing for Closure of Emergency Midline Laparotomy

Wound infections continue to represent a major medical problem, both in terms of how they affect the outcome of surgical procedures (surgical site infections), and for their impact on the length of hospital stay and medical costs. Many otherwise successful surgical operations fail because of the development of wound infections. A major SSI is defined as a wound that either discharges significant quantities of pus spontaneously or needs a secondary procedure to drain it Wound infection predisposes the patient to wound dehiscence. Acute wound failure is defined as postoperative separation of the abdominal musculoaponeurotic layers, within 30 days after operation. Most surgical wound infections become apparent within 7 to 10 days postoperatively. Objectives of the study 1. To assess local wound complication in emergency midline laparotomy wounds with interrupted figure of eight technique over conventional continuous closure . 2. To Compare the operative time for interrupted figure of eight closure and Conventional layered closure of laparotomy wounds. 3. To determine the factors affecting wound dehiscence. Materials and Methods: A prospective study was performed at Victoria hospital and Bowring and Lady Curzon hospital , Bangalore during November 2017 – May 2019. A sample of 100 cases were considered. Each Group consisted of 50. Group 1 underwent Interupted figure of Eight suture technique and Group 2 underwent continuous conventional suturing technique. Results: The incidence of burst abdomen in current study was 8%. There were two burst abdomen seen in conventional continuous closure technique and none in the interrupted figure of eight technique group. Conclusion: All the patients with generalized peritonitis in emergency setting need special attention regarding the wound closure. This newer technique of midline emergency laparotomy wound closure, especially in our part of the world significantly reduces the incidence of wound infection and wound dehiscence.

A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of &lt;0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

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

Background Burst abdomen is a very serious postoperative complication associated with high morbidity and mortality. It has a significant effect on health care cost, for both the patients and the hospitals. Purpose The aim of this study was to assess the incidence and perioperative risk factors of burst abdomen in patients undergoing emergency midline laparotomy. Patients and methods A prospective cohort study was conducted on 250 patients who underwent midline laparotomy at Kasr Al-Ainy Hospital Emergency Department, Cairo University, from August 2017 until August 2018. Factors such as age, sex, BMI, substance abuse, previous laparotomy, malignancy, diabetes mellitus, ascites, albumin, renal functions, bilirubin, hemoglobin, intra-abdominal pathology, suture material, creation of stoma, postoperative chest infection, postoperative paralytic ileus, leakage, and wound infection were observed and analyzed. Results Incidence of burst abdomen was 12.4%. Wound infections (87.1 vs. 18.7%, P Conclusion Important risk factors according to our study were wound infection, anemia, previous laparotomy, creation of stoma, hypoalbuminemia, ascites, diabetes, type of intra-abdominal pathology, with maximum incidences in peritonitis, postoperative cough, and postoperative leakage. Patient sex, age, associated morbidities such as jaundice and uremia, previous use of steroids, suture material used in closure, and postoperative paralytic ileus were not significant in our study.

A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

Graham Patch Versus Modified Graham Patch in the Management of Perforated Duodenal Ulcer

Introduction: Peptic ulcer perforation is a serious complication which affects 2-10% of peptic ulcer patients. It presents with an overall mortality of 10% although various authors had reported incidence between 1.3% and 20%. Being a life threatening complication of peptic ulcer disease, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be contained. Aims and objectives: To compare outcome and complications in Graham patch and Modified Graham patch repair in perforated duodenal ulcer.Material and Methods: A prospective randomized controlled trial was conducted to compare the outcome and complication viz. leakage, obstruction after Graham's patch repair and modified Graham's patch repair undergoing duodenal ulcer perforation in various surgical units of Nepalgunj Medical College Teaching Hospital. Out of these 60 patients; one group (30 cases) underwent Graham's patch repair and another group (30 cases) underwent modified Graham's patch repair. The outcome of procedure was measured in terms of complication like leakage, obstruction and mortality.Results: Duodenal ulcer perforation in group A was more common in male; 58(96.66%) patients were male 2 (3.33%) were female (M:F=29:1). The mean age was 46.80(SD 13.9) years. In Group B it was more common in male; 58(96.66%) patients were male 2(3.33%) were female (M:F=29:1). The mean age was 48.60(SD 14.04) years. Incidence of complication was more common in Group B, no statistically significant difference was found between two groups. The incidence of post operative leakage was 1(3.33%) and in Group B were 2(6.70%). The chi square test was used to compute the p value using SPSS 19. The chi square p value was calculated as 0.554. Hence there was no significant difference between the Group A and Group B. The incidence of burst abdomen was same 2(6.70%) in both the groups.Conclusion: The analysis of results of present study consisting of altogether 60 patients undergoing duodenal ulcer perforation repair showed that Graham's patch repair is as effective as modified Graham's patch repair in terms of morbidity and mortality. Hence there is no statistically significant difference in undergoing either procedure of repair. It is concluded that either procedure can be undertaken depending upon surgeon preference.Journal of Nepalgunj Medical College Vol.13(1) 2015: 28-31

Burst Abdomen: A Preventable Complication in Gynecological Oncology

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.