Pediatric Post-operative Abdominal Wound Dehiscence in Association With Midline vs Other Incisions in Tertiary Care Setting Kabul Afghanistan: A Cohort Study
Conditions: Wound Dehiscence, Incision
Sponsor: French Medical Institute for Mothers and Children

French Medical Institute for Mothers and Children  
Postgraduate Medical Education Program  
Pediatric Surgery Department  
Thesis protocol 
Dr. Abdullah Bahloli 
Pediatric post-operative abdominal wound Complications in 
association with midline vs transverse incision in tertiary care 
setting Kabul Afghanistan: A Cohort Study 
 
Name of Supervisors: Dr. Mohammad Tareq Rahimi, Head of Pediatric Surgery 
Name of Committee Members: Dr. Homayoon Atiq Ghairatmal, Pediatric Surgery Faculty 
Member, Dr. Nooria Atta MD, PGD, MSc (Epidemiologic Oncology) 
 
 
 
 
 
 
 
Year: 2018 
 
 
 

Pediatric post-operative abdominal wound Complications in 
association with midline vs transverse incision in tertiary care 
setting Kabul Afghanistan: A Cohort Study 
 
Introduction: 
Wound complications in pediatric abdominal surgery is associated with high mortality and 
morbidity,(1) Most reviews of these complication are in the adult medical literature(2), The 
incidence of wound complication in adults varies from center to center worldwide(3). it is 
recorded to be 1-3 % in most center(3), some centers in India recorded incidence of burst 
abdomen which is one of the serious abdominal wound complication is as high as 10-30%(3). 
Among abdominal wound complications burst abdomen is associated with a mortality rate as 
high as 45%(3). Burst abdomen is defined as post-operative separation of abdominal musculo-
aponeurotic layers.(4) it is thought to be as common in children as in adults.(2) Literature on risk 
factors for abdominal wound complications in children are limited.(5) Table 1. Incision type 
(midline or transverse) has also its effect on preventing wound complication.(6) according to 
literature review there is no update article and prospective study in pediatric field on wound 
complication, and to my knowledge no study has been done in Afghanistan related to this topic. 
In this study we will define possible wound complications related to incision type in a tertiary 
care hospital. 
 
Table 1 Literature concerning abdominal wound dehiscence in children(5) 
Author 
Year of 
publication 
No. of 
patients 
Incidence (%) 
Mortality (%) 
Statistical analysis 
Gross and Ferguson 
1953 
75 
0.9 
45.3 
NR 
Campbell and 
Swenson 
1972 
26 
0.97 
19.2 
NR 

Gruessner et al.  
1986 
21 
1.17 
14.3 
NR 
Waldhausen and 
Davies 
2000 
12 
0.43 
8.3 
Univariate 
Cigdem et al. 
2006 
27 
0.08 
34.5 
Univariate 
Van Ramshorst a 
2009 
63 
0.6 
11.1 
Multivariate 
 
 
 
 
 
 
NR not Reported 
a  Current Series 
Rational 
The study will find post-operative wound complications in association with incision type in a 
tertiary care hospital Kabul Afghanistan. To my knowledge there is no study available in 
Afghanistan’s medical literature related to this topic until now. In international literatures on risk 
factors for abdominal wound complications in children is limited.(5)  
 
Objective: 
 
Primary Objective: 
 This study is designed to find the association between incision type and postoperative wound 
dehiscence. 
Secondary Objective: 
 To find other risk factors for abdominal wound early complications. 
 
Question: 
What is the association between incision type (midline, transverse, others) and abdominal wound 
complications? 

Hypothesis: 
 
Null Hypothesis:  
There is no association between incision type and post-operative abdominal wound complication. 
Alternative Hypothesis:  
There is association between incision type and post-operative abdominal wound complication. 
 
Methodology 
 
Study design:  
Cohort Study 
 
Study population:   
all abdominal surgeries patient age under 18-year-old. 
 
Eligibility Criteria 
Exclusion criteria: 
 Umbilical hernia, patients already admitted for wound complication, laparoscopic 
surgery. 
Inclusion criteria:  
 urologic surgeries, all abdominal surgeries patient under 18-year-old. 
 

Setting:  
Pediatric surgery department FMIC, Ataturk children Hospital and Indira Gandhi children 
hospital: a multi-center study  
 
Data collection: 
Data Collection Form: In annex 1 
 
Data Collection Method:  
Data will be collected from patient’s file, lab reports and physical examination. 
Sampling Strategy: 
 Convenience 
Sample Size: 
All patient who will undergo abdominal surgery from January 2019 to June 2020 will be 
collected as a sample size. 
 
Data management:  
After collection of data it will be doubly entered in SPSS and data backup will be saved and a 
hard copy of data will be kept in safe place. 
Data Analysis: 
Plan for analysis: 
 
Statistical Package for Social Science (SPSS) version 25.0 will be used for statistical analysis. To 
analyze data firstly descriptive statistical methods will be applied. Mean +- standard deviation or 

median (IQR) will be calculated and used for representation of the quantitative data considering 
their distribution types. 
For categorical data frequencies and percentages (%) will be calculated. For comparison between 
groups of data specific methods (chi-square, t-test…) will be chosen and applied according the 
data type and distribution, number of groups and their dependency. 
To compare groups of data statistical test such as chi-square, t-test, Mann-Whitney U and other 
tests will be used accordingly. The significance level is set at p<0.05. 
 
Chi-square test for independence will be run to explore the association between two categorical 
variables. 
Study duration:  
From Nov 2018 to Jun 2020. Time table is attached in annex 1. 
Ethical Consideration: 
Permission will be taken from the Ministry of Public Health (MoPH) Institutional Review Board 
(IRB) and Ethical Review Committee (ERC) of French Medical Institute for Mothers and 
Children (FMIC), Kabul, Afghanistan. Approval from the head of Pediatric Surgery Department 
of FMIC will be taken for conducting the study. Data from patients used in this study will be 
extracted from medical records files and patient’s physical examination. This information will be 
confidential and the data will not be used for any other purpose and only specific record numbers 
will be used as a patient’s identity.  
 

Limitation of the Study: 
This study is only going to be conducted in French Medical Institute for Children (FMIC), 
therefore the conclusion of this study could be applicable in FMIC and similar centers.