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Burst abdomen: related factors and post-operative challenge for surgeons

Rajneesh Kumar, Ritu Kataria, Sahil Singh Bangar, Ankita Attri, Harsimran Singh, Arshdeep Jassal.

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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.

Key words: Wound dehiscence, Laparotomy, midline vertical incision

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