Matthias Mehdorn1, Linda Groos2, Ines Gockel2, Yusef Moulla2, Woubet Kassahun2, Boris Jansen-Winkeln2. 1. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. Matthias.mehdorn@medizin.uni-leipzig.de. 2. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Abstract
BACKGROUND: Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. METHODS: We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR. RESULTS: We included 504 patients in the analysis, 111 of those suffered from BA. We found intestinal resection (OR 172.510; 22.195-1340.796, p < 0.001), liver cirrhosis (OR 4.788; 2.034-11.269, p < 0.001) and emergency surgery (OR 1.658; 1.050-2.617; p = 0.03) as well as postoperative delirium (OR 5.058; 1.349-18.965, p = 0.016) as the main predictor for developing BA. The main reason for BA was superficial surgical site infection (40.7%). 110 patients received operative revision of the abdominal fascial dehiscence and 108 were eligible for BAR analysis with 14 cases of BAR. Again, post-operative delirium was the patient-related predictor for BAR (OR 13.73; 95% CI 1.812-104-023, p = 0.011). The surgical technique of using interrupted sutures opposed to continuous sutures showed a preventive effect on BAR (OR 0.143, 95% CI 0.026-0,784, p = 0.025). The implantation of an absorbable IPOM mesh did not reduce BAR, but it did reduce the necessity of BAR revision significantly. CONCLUSION: The use of interrupted sutures together with the implantation of an intraabdominal mesh in burst abdomen repair helps to reduce BAR and the need for additional revision surgeries.
BACKGROUND: Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. METHODS: We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR. RESULTS: We included 504 patients in the analysis, 111 of those suffered from BA. We found intestinal resection (OR 172.510; 22.195-1340.796, p < 0.001), liver cirrhosis (OR 4.788; 2.034-11.269, p < 0.001) and emergency surgery (OR 1.658; 1.050-2.617; p = 0.03) as well as postoperative delirium (OR 5.058; 1.349-18.965, p = 0.016) as the main predictor for developing BA. The main reason for BA was superficial surgical site infection (40.7%). 110 patients received operative revision of the abdominal fascial dehiscence and 108 were eligible for BAR analysis with 14 cases of BAR. Again, post-operative delirium was the patient-related predictor for BAR (OR 13.73; 95% CI 1.812-104-023, p = 0.011). The surgical technique of using interrupted sutures opposed to continuous sutures showed a preventive effect on BAR (OR 0.143, 95% CI 0.026-0,784, p = 0.025). The implantation of an absorbable IPOM mesh did not reduce BAR, but it did reduce the necessity of BAR revision significantly. CONCLUSION: The use of interrupted sutures together with the implantation of an intraabdominal mesh in burst abdomen repair helps to reduce BAR and the need for additional revision surgeries.
Authors: Gian Luca Baiocchi; Simone Giacopuzzi; Daniel Reim; Guillaume Piessen; Paulo Matos da Costa; John V Reynolds; Hans-Joachim Meyer; Paolo Morgagni; Ines Gockel; Lucio Lara Santos; Lone Susanne Jensen; Thomas Murphy; Domenico D'Ugo; Riccardo Rosati; Uberto Fumagalli Romario; Maurizio Degiuli; Wojciech Kielan; Stefan Mönig; Piotr Kołodziejczyk; Wojciech Polkowski; Manuel Pera; Paul M Schneider; Bas Wijnhoven; Wobbe O de Steur; Suzanne S Gisbertz; Henk Hartgrink; Johanna W van Sandick; Maristella Botticini; Arnulf H Hölscher; William Allum; Giovanni De Manzoni Journal: Ann Surg Date: 2020-11 Impact factor: 12.969