Mass closure of abdominal wounds following major laparotomy in jaundiced patients.

Previous clinical studies have demonstrated an increased incidence of wound dehiscence and incisional hernia formation in jaundiced patients following major laparotomy. Nearly all of these patients had their wounds closed in layers. In order to determine the rate of wound failure in jaundiced patients when a mass closure technique is used, 343 non-jaundiced patients undergoing biliary surgery and 62 jaundiced patients undergoing surgery have been studied. All the wounds were closed using a mass closure technique and the patients were seen regularly as outpatients. There were no wound dehiscences in either group (incidence 0%). Twenty seven (7.9%) of the non-jaundiced patients and 4 (9.8%) of the surviving jaundiced patients developed incisional hernias within one year of operation. We conclude that the rate of wound dehiscence in jaundiced patients can be much reduced using the mass closure technique. The rate of incisional hernia formation in jaundiced patients following major laparotomy is similar to that found in non-jaundiced patients when this technique is used.