ABSTRACT
Complete abdominal wound dehiscence "burst abdomen" is a challenging surgical complication and continue to be a major source of morbidity and mortality after laparotomies. The costs for managing burst abdomen are considerable, frequently requiring medical treatment, surgical intervention and prolonged hospital stay. Twenty six patients, who had burst abdomen, were seen between December; 2000 and April 2004 at Ain Shams University Hospitals. Fifteen patients were selected for conservative treatment [group A] and eleven patients were treated by classical abdominal mass closure with tension sutures [group B]. Patients selected for conservative treatment included those whose disruption occurred from the second postoperative week onwards, disruption occurred secondary to major wound sepsis or any intra-abdominal septic focus draining through the wound [without any evidence of intra-abdominal collections] or those with stable dehisced fascial defect that occurred at any time and under any circumstances, revealing amalgamated loops of bowel, which were adherent to wound edges [frozen abdomen]. Patients not falling into these categories were treated by mass closure. The mean hospital stay was 25 days in group A and 22 days in group B. Mortality was 20% [3 cases] among group A, all of them died in the early postoperative period from complications unrelated to the conservative protocol. Mortality was 36.4% [4 cases] among patients of group B, 50% of them died from intra-operative mishaps occurred at the time of closure [small intestinal injury]. Follow-up for 8 months or more was complete in 10 patients in group [A] and in 7 patients in group [B]. Four incisional [ventral] hernias were noted among 10 patients treated conservatively and followed up for more than 8 months. Repair was required in two patients [20%]. The other two patients had only diffuse protrusion during coughing or straining because of stretched weak scar without localized defects and required no further treatment. Two ventral hernias [28.6%] with multiple defects were seen in the survived 7 patients of group B, both of them has been repaired using polyprolene mesh. The results of this study strongly document the safety and efficacy of conservative treatment as an alternative method in treating abdominal wall dehiscence in certain situations. We believe this to be the method of choice in cases where the bowel loops are adherent to the wound edges, where the wound is infected and oedematous, when closure can only be done under tension and in high risk patients unfit for operation