Mechanical factors influencing the incidence of burst abdomen
Niggebrugge, A.H.; Hansen, B.E.; Trimbos, J.B.; van de Velde, C.J.; Zwaveling, A.
European Journal of Surgery 161(9): 655-661
1995
ISSN/ISBN: 1102-4151 PMID: 8541424 Document Number: 452530
Objective: To compare laparotomy closure with interrupted polyglactin 910 (Vicryl) and continuous polydioxanone (PDS II), and assess the mechanical and other factors that influenced the incidence of burst abdomen. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects: A random sample of 346 patients who did not burst their abdomens, taken from the total of 3768 patients who underwent primary midline laparotomy from 1986-1990, together with the 45 (1%) from the total series who did burst their abdomens. Main outcome measures: Incidence of burst abdomen, and the association with mechanical and others risk factors. Results: There were no differences in the incidence of burst abdomen between those sutured with interrupted polyglactin 910 and those sutured with continuous polydioxanone (p = 0.12). Layered closure resulted in significantly more burst abdomens than any other method of closure (p lt 0.001 in each case). Postoperative wound infection (14/43, 33%, compared with 33/343 10%) and pulmonary complications (25/43, 58%, compared with 44/344, 13%) were also significantly associated with the development of burst abdomens (p lt 0.001). Conclusions: A continuous, monofilament, absorbable suture should be used to close a laparotomy incision. Elastic suture material, loop sutures, an the continuous figure-of-eight technique should be investigated.