Evaluation of the risk factors in abdominal wounds dehiscence

ABSTRACT

Postoperative abdominal wound dehiscence is still a great surgical problem. Though it is not very common, but may cause a serious complication leading to death. To evaluate risk factors associated with postoperative abdominal wound dehiscence. Thirty-seven patients, 25 males and 12 females, with postoperative abdominal wound deniscence [burst abdomen] were identified during the period from Jan.2000-Dec.2002. On evaluation of these cases we stressed on the associated risk factors that might participate in the development of such complication, these are [1] Hypoalbuminemia [2] Anemia [3] Malnutrition [4] Chronic lung disease [5] Emergency surgery [6] Surgeon's experience [7] Repeated vomiting [8] Prolonged intestinal paralysis [ileus]. [9] Repeated urinary retention [10] Increased coughing [11] Local wound infection. We grouped the patients accordingly to the number of risk factors. Group [1] with no risk factor, group [2] with one risk factor, group [3] with two risk factors, group [4] with three risk factors, and group [5] with four or more risk factors. The majority of patients had one or more of risk factors. Two patients 5.4% with one risk factor, five patients 13.5% with two risk factors, nine patients 24.35% with three risk factors, twenty patients 54.05% had four or more risk factors and one patient 2.7% had no risk factors. No statistical differences in the increased tendency to postoperative abdominal wound dehiscence with the increased number of risk factors among the first three groups, but group four with the 3 risk factors was significally different [P value< 0.01], the same applied for group five too. No differences in the approach of the operation, whether median or Para median incisions, were related to the development of burst abdomen. The majority of burst abdomens were noticed to follow emergency operations 86.5% as opposed to cold operations 13.5%. Special attention should be paid for patients who had, at least, three risk factors for the development of burst abdomen; such patients should be considered for non-absorbable tension suture