Wound healing in obstructive jaundice

Wound healing has been investigated in 373 patients undergoing surgery for obstructive jaundice and 760 anicteric patients undergoing cholecystectomy. Reduced wound healing manifested by a higher frequency of wound dehiscence (3.2 per cent vs. 0.5 per cent) and incisional hernia (10.3 per cent vs. 1.8 per cent) was seen in the jaundiced patients. The factors related to this reduced wound healing have been analysed by univariate and multivariate analysis. The independent factors related to wound dehiscence in the 373 jaundiced patients were: an initial low haematocrit (less than 30 per cent), an initial low plasma albumin (less than 30 g/l], a history of pancreatitis, a malignant obstructing lesion, and postoperative wound and/or abdominal sepsis. Haematocrit, albumin and postoperative wound and/or abdominal sepsis were also independent factors for incisional hernia. A raised plasma bilirubin was not of independent significance for either wound dehiscence or incisional hernia. It is concluded that reduced wound healing occurs in jaundiced patients and that this is due to the associated features of poor nutritional status (manifested by low haematocrit and low albumin) and malignancy and not to the raised bilirubin per se.