A Prospective Study of 60 Cases of Emergency Exploratory Laparotomy with Incidence of Postoperative Wound Dehiscence, Its Etiology and Management

Background: Surgical site infection and wound dehiscence are the most common postoperative complications of emergency abdominal surgery in class 3 contaminated /class4 dirty of wound classification. Greatly increasing the mortality as well as morbidity of patients, in addition to prolonging hospital stay. Factors affecting the SSI are emergency surgery, age, sex, anaemia, nutrition, co-morbidities. Methods: This is a 6 months prospective study carried on 60 patients of more than 18 years age operated in department of surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh after permission with institutional ethical committee. Results: Incidence rates of SSI were 53.3% and of wound dehiscence 43.3% with male to female ratio 4:1 and most common age group being 41-50 years followed by 31-40 years. Most common associated illness was respiratory diseases, anaemia and malnutrition. SSI and wound dehiscence were mainly occurred 5th to 7thpost-operative day presented as erythema, pain and pus discharge. Wound swab for culture & sensitivity were sent and debridement done. Staphylococcus and Klebsiella were commonly causative bacteria and SSI best controlled by injection gentamycin, meropenem, piperacillin+tazobactam and colistin. After control of infection wound were allowed to heal (1) conservatively with dressing and abdominal binder or (2) with delayed suturing. Conclusion: Although incidence of postoperative wound dehiscence in emergency exploratory laparotomy was high as 43.3% but this can be decreased by proper planned preoperative patient preparation,adequate antibiotic prophylaxis and better surgical expertise.