Prevention and treatment of major complications after closure of abdominal wall and repair of abdominal wall hernias

Abstract

Wound complications that occur after closure of laparotomy remain challenging. Early wound complications included subcutaneous wound infection, deep wound infection, dehiscence, fistula, and suture sinus. Surgical site infections and wound and tissue dehiscence are the most frequent postoperative complications in gastrointestinal surgery that surgeons have to deal with, and usually both of them are related one to another. In fact, concurrent infection is a risk factor for abdominal wound dehiscence, and the prevention of wound infection would reduce substantially the incidence of dehiscence and herniation in abdominal wounds. Presence of bacteria in the healing tissue affects all processes of healing and promotes impairment of collagen synthesis and release of proteolytic enzymes, which promotes dehiscence by decreasing the suture-holding capacity of the tissue. When present, infection and disruption of wounds and tissues were associated with a higher risk of reoperation and a prolonged postoperative admission. On the other hand, common for all tissues subject to surgery is disruption of the local vascular supply, thrombosis of the vessels, and tissue hypoxia that also have some influence in the proliferation of bacteria in the wound and tissue, which affects each process involved in healing and increases the risk of wound infection, delayed healing, and dehiscence.