THE EFFICACY OF NEW SCORING SYSTEM TO PREDICT BURST ABDOMEN.

Dr Sreenidhi G M, Dr Vidyashri Hanmanthappa Biral, Dr Fransisco V Jose

Abstract


INTRODUCTION: The frequency of burst abdomen in the international data ranged from 0.4% to 3.5%.1-3  and in India it is about 4.8-6.6% 4-5 . Wound dehiscence is the partial or complete disruption of an abdominal wound closure with or without the protrusion or evisceration of abdominal contents. Dehiscence of the wound occurs before the cutaneous healing. It is associated with the mortality of-19-45%6. Because of its high mortality, it is essential to use preventive steps in the peri-operative period.

The major risk factors for burst abdomen are-Malnutrition, obesity,  anemia, infection, cough, distention of abdomen, malignancy, diabetes mellitus and immunocompromised state. Frequency of burst abdomen is higher following emergency laparotomies (14.89%) than elective laparotomy (2.7%). Prophylactic reinforced tension suturing prevents burst abdomen.

MATERIALS AND METHODS: The study conducted includes 144 patients who underwent laparotomy   under emergency and elective basis. Pre-operative and post-operative examination was  done and scoring was done for 13 indices. Patients were followed up for 11 days post-operatively and daily examination of the operated site was done.

RESULT- In the study of 144 patients 122 were operated on emergency basis and 22 on elective basis. Out of total cases 84 patients had score of more than 10(high risk) and 60 patients with low risk. Out of the high risk cases 18 had burst abdomen.


Keywords


Burst abdomen, causes, high risk, emergency laparotomy.

Full Text:

PDF

References


Swaroop M, Williams M, Greene WR, Sava J, Park K, Wang D. Multiple laparotomies are a predictor of fascial dehiscence in the setting of severe trauma. Am Surg 2005;71:402-5.

Waqar SH, Malik ZI, Razzaq A, Abdullah MT, Shaima A, Zahid MA.Frequency and risk factors for wound dehiscence/burst abdomen in midline laparotomies. J Ayub Med Coll Abbottabad 2005;17:70-3.

Kirshtein B, Roy-Shapira A, Lantsberg L, Mizrahi S. Use of the “Bogota bag” for temporary abdominal closure in patients with secondary peritonitis. Am Surg 2007;73:249-52

Adnan A, Shams NA, Irfan S, Manzar S. Abdominal wound dehiscence: An ongoing dilemma. Pak J Surg 2009;25:204-8.

Murtaza B, Saeed S, Sharif MA. Postoperative complications in emergency versus elective laparotomies at a peripheral hospital. J Ayub Med Coll Abbottabad 2010;22:42-7

Fleischer GM, Rennert A, Rühmer M. Infected abdominal wall and burst abdomen. Chirurg 2000;71:754-62.

Afzal S, Bashir MM. Determinants of wound dehiscence in abdominal surgery in public sector hospital. Annals of King Edward Medical University. 2010 Apr 1;14(3):119.

Robert J, Fittzgibons JR. Nyhus and Condons hernia. Diagnostic and Imaging of abdominal wall hernia, 5th Ed., Lippincott Williams; 2002.

Gabrielle H, van Ramshorst, Nieuwenhuizen J, Hop WCJ, Arends P, Boom J, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg. 2010;34:20-7.

Spiliotis J, Konstantino S, Siveriotis T, Datsis AD, Archodaula, Georgios, et al. Wound dehiscence. World J Emerg Surg. 2009;4:12.

Waqer S, Malik Z, Razzaq A, Abdullah MT, Shaima A, Zahid MA. Frequency and risk factors for wound dehiscence/burst abdomen in midline laparotomies. Journal Ayub Med Coll. 2005;17(4):70-3.

Lofty W.Burst abdomen:Is it a preventable complication?.Egyptian J Surg.2009;28(3):128-32

Halasz NA.Dehiscence of laparotomy wounds.Am J Surg.1968;116(2):210-4

Riou JP,Cohen JR,Johnson H.Factors influencing wound dehiscence.Am J Surg.1992;163(3):324-30

Gurleyik G.Factors affecting disruption of surgical abdominal incisions in early post-operative period.Ulus Travma Derg 2001;7:96-9

Webster C,Neumayer L,Smout RE,Horn S,Daley J,Henderson W,Khuri S: National Veterans affairs surgical quality improvement program.Prognostic models of abdominal wound dehiscence after laparotomy.J Surg Res 2003,109:130-137.

Van Ramshorst GH,Nieuwenhuizen J,Hop WCJ:Abdominal wound dehiscence in adults: Development and Validation of risk model.World J Surg Res 2010,34:20-27

Jones V, Bale S, Harding K: Acute and chronic wounds. Wound care essentials: Practice principles. In Philadelphia: Lippincott, Williams, & Wilkins; 2004.

Burger JW, Van't Riet M, Jeekel J: Abdominal incisions: techniques and

postoperative complications. Scand J Surg 2002, 91:315–321.

Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A: Incisional hernia related risk factors. Surg 2003, 20:3–9.

Afzal S, Bahir MM: Determinants of Wound Dehiscence in Abdominal Surgery in Public Sector Hospital. Annals 2008, 14(3):110–114.

Seleh M, Hill A, Hill AG: Smoking is a major risk factor of wound.


Refbacks

  • There are currently no refbacks.