A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy

Kusum Meena, Shadan Ali, Awneet Singh Chawla, Lalit Aggarwal, Suhani Suhani, Sanjay Kumar, Rehan Nabi Khan

Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.
Department of Surgery, Safdarjung Hospital, New Delhi, India.
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.

DOI: 10.4236/ss.2013.48070                

Abstract

Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.

Keywords

Laparotomy; Perforation Peritonitis; Intra-Abdominal Pressure; Abdominal Wound Dehiscence; Transforming Growth Factor

Conflicts of Interest

The authors declare no conflicts of interest.

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