[Factors affecting disruption of surgical abdominal incisions in early postoperative period]

Disruption of abdominal surgical wounds is one of the common causes of early re-laparotomy. Because of high mortality, medical and surgical preventive measures are essential in primary peri-operative period. Good knowledge of risk factors is mandatory for prophylaxis. In this study we aimed to elucidate some factors contributing to disruption of incisions. In a period of the last 25 years hospital records of 38 cases of abdominal evisceration following major abdominal surgery were analysed retrospectively. Disruption rate is found as 0.92%. Seventy-six percent of 38 patients are men with a mean age of 58 years, and 79% over 50 years of age. Sixty-one percent of primary operations were performed under emergency conditions. Malignant tumours(21%), infectious diseases(21%) and intestinal obstructions(18%) and obstructive jaundice(16%) were the most common primary pathologies as indications of surgery. Wound infection, entero-cutaneous and bilious fistula formation were found as causes affecting wound healing in the postoperative period. Obvious regional and local severe infection is present in 44% of the cases. Two or more factors are contributing to evisceration in great majority(79%) of patients. Mortality was 37% after re-laparotomy for surgical correction of evisceration by support of retention sutures or synthetic mesh. In conclusion, advanced age, the presence of malignancies, jaundice, intraperitoneal infections, disease increasing intraabdominal pressure, and postoperative wound infection and fistula formation were found as factors affecting wound healing process, and leading to evisceration. Early re-laparotomy for correction of evisceration and evisceration itself causes high mortality rate in high risk patients due to primary pathologies and preexisting co-morbid conditions.