Surgical Wound Dehiscence Following Midline Laparotomy Closure: Does Retention Suture Help to Reduce Dehiscence Rate?

Abstract

Objectives: 1) To evaluate the rate of wound dehiscence following midline laparotomy closure 2) To analyze risk factors for surgical wound dehiscence 3) To determine whether retention sutures have effect on the rate of surgical wound dehiscence Materials and Methods: A prospective study of patients who underwent elective midline laparotomy in the Department of Surgery of Lithuanian University of Health Sciences was performed. Risk factors for dehiscence were evaluated preoperatively and postoperatively. Patients were determined to be “low risk” (0-2 risk factors) or “high risk” (>2 risk factors). Low and high risk patient were divided into groups by whether additional retention sutures (RS) were applied (RS+) or not (RS-). Midline abdominal incisions were sutured according to European Hernia Society guidelines. PDS CTX 1-0 slowly-absorbable monofilament suture with 48 mm 1/2 circle needle was used for abdominal closure. Same type of monofilament was used for RS. Wound dehiscence was evaluated during sonography of surgical wound area. Student’s t-test was used to compare parametric, χ2 test and Mann-Whitney U test – nonparametric variables between groups. Logistic regression analysis was used to determine independent risk factors for dehiscence. Results: 185 patients underwent elective midline laparotomy for various causes. The mean age of patients was 61.6816.10 years. Preoperative risk factors for dehiscence were evaluated by analyzing patients’ medical history. Postoperative risk factors were assessed during patients’ hospital stay. We have determined that uremia (p=0.028), chronic obstructive pulmonary disease (p=0.035), hypoalbuminemia (p=0.013), hemoglobin <100 g/l (p=0.002), intra-abdominal abscess (p=0.001), jaundice (p=0.020), surgical site infection (p<0.001) and anastomotic leak (p<0.001) were independent risk factors for wound dehiscence. 89 patients were “low risk”, with RS [...].