TITLE:
A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy
AUTHORS:
Kusum Meena, Shadan Ali, Awneet Singh Chawla, Lalit Aggarwal, Suhani Suhani, Sanjay Kumar, Rehan Nabi Khan
KEYWORDS:
Laparotomy; Perforation Peritonitis; Intra-Abdominal Pressure; Abdominal Wound Dehiscence; Transforming Growth Factor
JOURNAL NAME:
Surgical Science,
Vol.4 No.8,
July
23,
2013
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.