STUDY TO REVEAL THE EFFECTIVE WAY TO MANAGE THE ABDOMINAL WALL DEHISCENCE

Objective: To investigate an effective way to separate the abdominal wound dehiscence following emergency and elective laparotomies.

Study Design: A comparative cross-sectional study.

Place and Duration: In the Surgical Unit II of Holy Family Hospital, Rawalpindi for one year duration from July 2017 to July 2018.

Materials and Methods: In the emergency or elective surgeries, 100 consecutive patients undergoing midline incision and laparotomy were included in the study. In order to see normal recovery, a wound examination was performed from the second postoperative day and the findings were recorded. Group A wound injuries were managed with full abdominal lavage and deep tension sutures and B group applied with Bogota bag application and abdominal wash.

Results: Fifteen (11.5%) of the 130 patients developed full wound dehiscence (trapped abdomen). The incidence of abdominal rupture was significantly higher after emergency laparotomies (14/94, 14.89%), whereas one patient underwent elective laparotomy (1/36, 2.7%). Group A (n = 8) was managed with deep tension sutures and group B (n = 7) was treated with Bogota Bag. The results of deep tension sutures were associated with less morbidity, less surgery and lower mortality.

Conclusion: Complete abdominal lavage with normal saline and closure with deep tension sutures is still an effective treatment in patients with complete wound dehiscence. Cases of abdominal closure due to a generalized intestinal edema or the need for further reoperation.

Key words: Midline laparotomy, Abdominal wound dehiscence, Bogota bag, deep tension suture, burst abdomen.