Mechanical factors influencing the incidence of burst abdomen.
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.


METHODS
Retrospective study.


METHODS
University hospital, The Netherlands.


METHODS
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.


METHODS
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.
Niggebrugge
A H
AH
Department of Surgery, University Hospital Leiden, The Netherlands.
Hansen
B E
BE
Trimbos
J B
JB
van de Velde
C J
CJ
Zwaveling
A
A
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D016687:Polydioxanone / Q000627:therapeutic use*; D011098:Polyglactin 910 / Q000627:therapeutic use*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D014945:Wound Healing
D016687:Polydioxanone; D011098:Polyglactin 910