title: [Risk factors for acute abdominal wall dehiscence after laparotomy in adults].
abstract: BACKGROUND
  Total evisceration consists of protrusion of the abdominal viscera due to dehiscence of all the planes of the abdominal wall after laparotomy. The greater the number of risk factors, the greater the probability of evisceration.
  
  
  METHODS
  We performed a retrospective study of patients with evisceration treated in the previous 9 years.
  
  
  RESULTS
  Among 12,622 patients who underwent laparotomy, 57 eviscerations were detected (45 men, 12 women; mean age 70 years). The diagnosis was peritonitis in 26 patients and intestinal occlusion in 19. Emergency surgery was performed in 48 patients. Reintervention was performed in 12 patients. Postoperative complications were found in all patients, especially wound infection and paralytic ileus. The main clinical finding was staining of the dressing. Laboratory investigations revealed leukocytosis, hypoproteinemia, and anemia. Surgical repair consisted of simple closure and/or retention sutures; mesh was associated in 6 patients. Subsequent morbidity was 77%. Twenty-six patients required admission to the intensive care unit. The mean length of hospital stay was 28.5 days. The were 41 recoveries (72%) and 16 deaths (28%). Review of 18 parameters involved in evisceration showed that 80% (45 patients) presented 9 or more risk factors.
  
  
  CONCLUSIONS
  Evisceration is a serious occurrence that produces high morbidity and mortality. The most frequent risk factors in our series were age greater than 65 years, hemodynamic instability, increased intra-abdominal pressure, emergency surgery, infection of the wound or abdominal wall, hypoproteinemia and anemia. Because these risk factors can be predicted, when several are grouped together, reinforcement should be used when closing the abdominal wall.
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Dr. Josep Trueta, Girona, Spain. joserod@eresmas.net
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Rodríguez-Hermosa
authors.forename: Antoni
authors.initials: A
authors.lastname: Codina-Cazador
authors.forename: Bartomeo
authors.initials: B
authors.lastname: Ruiz
authors.forename: Josep
authors.initials: J
authors.lastname: Roig
authors.forename: Jordi
authors.initials: J
authors.lastname: Gironès
authors.forename: Marcel
authors.initials: M
authors.lastname: Pujadas
authors.forename: Josep
authors.initials: J
authors.lastname: Pont
authors.forename: Xavier
authors.initials: X
authors.lastname: Aldeguer
authors.forename: Doroteo
authors.initials: D
authors.lastname: Acero
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*