Burst Abdomen in Emergency Midline Laparotomy: Incidence and Risk
Condition: Wound Dehiscence
MeSH terms: Emergencies
Study type: Interventional

Summary: 
      The study was conducted in 250 patients who underwent midline Laparotomy at Kasr Al-Ainy
      emergency department, Cairo University from August 2017 until March 2018. Factors such as age
      ,sex, body mass index, substance abuse, previous laparotomy, malignancy, diabetes mellitus ,
      ascites, albumin, renal functions, bilirubin, hemoglobin, intra-abdominal pathology, suture
      material, creation of stoma, post-operative chest infection, , post-operative paralytic
      ileus, leakage and wound infection were observed and analyzed with odds ratio and P value
    

Detailed description: 
      General Anaesthesia can be appropriate for patients undergoing abdominal surgery. In common
      practice with rapid sequence induction with inhalational anesthetics (sevoflourane or
      isoflourane), opioids (fentanyl 1-2 mic/kg with induction & morphine 0.1 mg/kg) and
      neuromuscular blockers (succinylcholine 0.5 mg/kg or roucroinium 0.9 mg/kg) are used in
      general anesthesia for abdominal surgical procedures.

      Once an adequate level of anesthesia has been reached, the initial incision into the skin may
      be made. A scalpel is first used to cut into the superficial layers of the skin.with the
      diathermy The incision is then continued through the subcutaneous fat, the abdominal muscles,
      and finally, the peritoneum.

      For all the patients, closure of midline laparotomy wound was en-mass closure done with
      non-absorbable No. 1 (Polypropylene) or slowly absorbable (PDS) (double loop). sutures in
      continuous single layer fashion with 1 cm interval.

      The operative details were recorded with special consideration to the operative diagnosis,
      presence and types of adhesions, duration of surgery, the need for diversion and stoma
      formation, the use of intraperitoneal drain and the suture material to close the rectus
      sheath.

      During the postoperative period, VAS assessment of postoperative pain at 1 , and 24 hours,
      time of ambulation, time of oral feeding, hospital stay, and postoperative hemoglobin were
      recorded.Any postoperative complication especially chest infection, wound infection,
      postoperative leakage and postoperative paralytic ileus were reported.

      Follow up of all cases was done weekly after discharge for 4 weeks. Examination of wound
      included inspection for any redness, edema or presence of discharge like pus or
      serosanguinous fluid. Special attention was given to maintain asepsis. Broad spectrum
      intravenous antibiotics The antibiotic therapy for the treatment of intra-abdominal
      infections greatly varies according to the infection severity. It is, in fact, possible to
      distinguish the intra-abdominal infections in three different categories. Mild infections
      should be treated promptly with surgical drainage and a short term therapy with a wide range
      antibiotic including anaerobes (ampicillin/sulbactam, cefoxitin). Mild-moderate infections
      which are largely the most frequent in the clinical practice should be also treated with a
      single drug which include anaerobes in its spectrum. Finally severe infections require a more
      aggressive therapeutic approach with a combination treatment covering anaerobes (clyndamicin,
      metronidazole), Gram negative rods (ciprofloxacin, aminoglycosides) and Gram positive cocci
      (penicillins, cephalosporins) including MRSA (glycopetides) and/or VRE (linezolid). with
      anaerobic coverage was started for all cases and later changed according to culture and
      sensitivity report.

      During follow up duration, the participants were assigned to one of two groups. Group I
      involved patients developed burst abdomen whether partial (bowel not eviscerated) or complete
      (bowl not eviscerated) and group II involved those who didn't develop it. Half of Sutures
      were removed after 10 days , all the sutures removed after 14 days.
    

Intervention name(s): emergency midline exploratory laparotomy
Intervention type(s): Procedure
Intervention description(s): Once an adequate level of anesthesia has been reached, the initial incision into the skin may be made. A scalpel is first used to cut into the superficial layers of the skin.with the diathermy The incision is then continued through the subcutaneous fat, the abdominal muscles, and finally, the peritoneum. (Morris J ;2017) For all the patients, closure of midline laparotomy wound was en-mass closure done with non-absorbable No. 1 (Polypropylene) or slowly absorbable (PDS) (double loop). sutures in continuous single layer fashion with 1 cm interval. (Morris J ;2017) The operative details were recorded with special consideration to the operative diagnosis, presence and types of adhesions, duration of surgery, the need for diversion and stoma formation, the use of intraperitoneal drain and the suture material to close the rectus sheath.
Other intervention name(s): midline exploratory laparotomy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Screening