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 mec hanical and other factors that influenced the incidence of burst abdom en. Design: Retrospective study. Setting: University hospital, The Net herlands. Subjects: A random sample of 346 patients who did not burst their abdomens, taken from the total of 3768 patients who underwent pr imary midline laparotomy from 1986-1990, together with the 45 (1%) fro m 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 inciden ce of burst abdomen between those sutured with interrupted polyglactin 910 and those sutured with continuous polydioxanone (p = 0.12). Layer ed closure resulted in significantly more burst abdomens than any othe r method of closure (p < 0.001 in each case). Postoperative wound infe ction (14/43, 33%, compared with 33/343 10%) and pulmonary complicatio ns (25/43, 58%, compared with 44/344, 13%) were also significantly ass ociated with the development of burst abdomens (p < 0.001). Conclusion s: A continuous, monofilament, absorbable suture should be used to clo se a laparotomy incision. Elastic suture material, loop sutures, an th e continuous figure-of-eight technique should be investigated.