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Mechanical factors influencing the incidence of burst abdomen
A H Niggebrugge1, B E Hansen, J B Trimbos
1Department of Surgery, University Hospital Leiden, The Netherlands.
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 < 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 < 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.