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ORIGINAL ARTICLE
Year : 2017  |  Volume : 36  |  Issue : 3  |  Page : 199-207

Burst abdomen: should we change the concept, preliminary study


Emergency Unit, General Surgery Department, Kasr Al Ainy University Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Sherif M Mokhtar
Emergency Unit, General Surgery Department, Kasr Al Ainy University Hospital, Faculty of Medicine, Cairo University, Giza
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1121.211706

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Background Burst abdomen represents one of the most frustrating and difficult postoperative complications encountered by surgeons who perform a significant volume of surgery. Burst abdomen occurs because of various preoperative, operative and postoperative factors, which can be prevented to some extent by being aware of them. The choice of incision for laparotomy depends on the area that needs to be exposed, the elective or emergency nature of the operation, and personal preference. Type of incision may, however, have an influence on the occurrence of postoperative wound complications, which is discussed in our study. There is little consensus in the literature as to whether a particular incision confers any advantage. Objective The purpose of this study was to provide an evidence-based consensus regarding the patients who underwent laparotomy for various intra-abdominal conditions included in our inclusion criteria and who developed burst abdomen in relation to the type of abdominal incision (vertical vs. transverse), as well as to know the rates of incidence, morbidity and mortality due to burst abdomen, and study other variables within the scope of postoperative complications. Other variables within the postoperative complications spectrum were also studied alongside the main one, burst abdomen. Patients and methods This is a prospective, randomized study (by card picking under supervision of the ward nurse) that compared the postoperative complications (mainly burst abdomen) after two main types of abdominal incisions, vertical and transverse, within a period of 12 months from October, 2015 to October, 2016. The study was conducted at the Emergency Unit, General Surgery Department, Kasr Al Ainy University Hospital, Faculty of Medicine, Cairo University. Sixty patients underwent open abdominal operations (exploration) after following distinctive inclusion and exclusion criteria. Thirty patients underwent vertical and thirty patients underwent transverse incisions. The main outcome measures were early complications such as burst abdomen, pulmonary complications and hospital stay. Results The transverse incision offers as good an access to most intra-abdominal structures as a vertical incision. The incidence of burst abdomen is higher in the vertical incision (midline) group, with 71.4% of the total patients suffering a burst abdomen. Respiratory complications occurred significantly in cases of burst abdomen (P<0.001). Hence, hospital stay was longer in cases of burst abdomen (P<0.001), which added to the economic burden. Conclusion Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. It should be preferred, as the early postoperative period is associated with fewer complications (burst abdomen and pulmonary morbidity). A midline incision is still the incision of choice in conditions that require rapid intra-abdominal entry (such as trauma with suspected intra-abdominal haemorrhage).


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