Abdominal wound disruption: a retrospective study

The occurrence of abdominal wound dehiscence is studied in a group of patients including 2205 patients treated via laparotomy over a period from June 1987 to Sept. 1991 in the Department of General Surgery; Assiut University Hospital. The incidence, age, sex, primary disease which required surgery, operations performed, preoperative and postoperative factors, of disruption, morbidity and mortality, have been analysed. The incidence of dehiscence was 2.2% [50 cases], the average age was 50 years and the condition occurred more frequently in males than females, the ratio being 1.27:1. Factors predisposing to abdominal wound disruption in our patients were; wound sepsis in 35 patients, distension in 29 patients, anaemia and malnutrition in 13 patients. The indication for the original operation in patients with dehiscence was emergent in 28 patients [56%] and elective in 22 [44%]. Right paramedian incision was used in 38 patients [76%]. Left paramedianin 9 patients [18%], and midline incision in 3 cases [6%]. Disruption occurred most commonly in the second postoperative week: 20 cases [40%] in the ninth postoperative day, 15 cases [30%] in the tenth day; 7 patients [14%] in the eighth day and 8 cases [16%] in the 5th to 7th day. No cases were recorded before the fifth or after the tenth postoperative days. After repair 38 patients [75%] recovered uneventfully and 12 patients [25%] died. We noticed that 8 out of the 12 died patients proved to have advanced malignant diseases

Hepaticojejunostomy for bile duct injuries after cholecystectomy

This study included 19 patients [11 females and 8 males]. The patients presented with jaundice [6 cases] or external biliary fistula [13 cases] after previous cholecystectomy operation. The patients were subjected to ultrasonographic examination and fistulography was done in patients presented with a fistula. Hepaticojejunostomy was done in all cases: In 3 cases simple loop hepaticojejunostomy and in the remaining 16 cases Roux en Y hepaticojejunostomy was carried out. A stent was used in all cases and left in place for 6 weeks then they were removed. Complications occurred in form of leakage closed spontaneously in one case and subphrenic collection in another case. Follow up of the patients revealed no complications. We advise the use of hepaticojejunostomy for restoration of bile flow after injuries of the bile ducts as it is safe, easy to construct and could be done in most cases