Incidence and risk factors influencing morbidity and mortality in cases of burst abdomen after emergency and elective midline laparotomies

Abstract

Background: Burst abdomen is a serious postoperative complication faced by surgeons and of greatest concern because of risk of evisceration, the need for immediate intervention and the possibility of repeat dehiscence. Wound dehiscence carries with it a substantial morbidity and mortality. In addition, there is an increase in the cost, increased hospital stays, nursing and manpower cost in managing its complications.Methods: In this study a total 202 patients enrolled who underwent emergency and elective midline laparotomies. Patients clinically presenting as gaping of abdominal wound were included in study. Diagnosis was established by clinical examination. In all cases gentle probing of the wound with gloved finger done to confirm defect.Results: In this study incidence of burst abdomen was seen in 80 patients (39.6%) and was common in patients who underwent emergency surgeries. Patients who had stoma construction had maximum number of burst abdomen. 150 (74%) cases underwent emergency laparotomies in which 64 (42%) cases developed burst abdomen. In 60 cases closure done with re-suturing of fascia and remaining cases by skin closure only due to sepsis, poor general condition of patients. Mortality was seen in (22.5%) patients due to postoperative complicationsConclusions: Burst abdomen is more common in emergency surgeries than elective surgeries. Wound infection and stoma construction increase the rate of burst abdomen. Mid-mid line incisions have increased incidence of wound dehiscence. Mortality is high despite early treatment due to complications.