Therapeutic alternatives for burst abdomen.

Burst abdomen is a postoperative complication associated with significant morbidity and mortality. The risk factors for burst abdomen are patient- and surgery-related. The management of this complication is a relatively unexplored area within the field of surgery. Relevant surgical outcomes include recurrence, mortality, and incisional hernia. A total number of 27 studies are identified that reported on at least one surgical outcome (recurrence, mortality, or incisional hernia rate) of at least 10 patients with burst abdomen. None of the identified studies were designed prospectively, and only a minority of studies reported surgical outcomes of considerable numbers of patients with burst abdomen. Reported conservative management options included use of saline-soaked gauze dressings and negative pressure wound therapy. Operative management options included temporary closure options (open abdomen treatment), primary closure with various suture techniques, closure with application of relaxing incisions, use of synthetic (nonabsorbable and absorbable) and biological meshes, and the use of tissue flaps. The treatment of burst abdomen is associated with unsatisfactory surgical outcome. Randomized controlled clinical trials are needed to provide the surgical community with a greater level of evidence for the optimal treatment strategy for burst abdomen and the various subtypes.