Closure of burst abdomen after major gastrointestinal operations-comparison of different surgical techniques and later development of incisional hernia

Objective: To find out the incidence of incisional hernia in patients who h ad resuture of a burst abdomen and to compare different methods of wound cl osure and the development of incisional hernia. Design: Retrospective study. Setting. University hospital, Norway. Subjects: 78 adults patients who had their burst abdomens resutured between January 1986 and December 1995. Interventions: Five different methods were used to close the burst abdomen: interrupted or continuous sutures with or without retention sutures, or re tention sutures alone. Main outcome measure: Incisional hernia after at least one year follow-up. Results. Postoperative mortality was 14% (11/78), and 53 patients were foll owed up for at least a year. Incisional hernias developed in 43% (23/53) of the patients. When interrupted sutures were used (with or without retentio n sutures) 34% (13/38) of patients developed incisional hernias compared wi th 6/10 when the wound was closed with a continuous suture. Retention sutur es did not reduce the incidence of incisional hernia. Conclusions: Incisional hernia is a common complication after resuture of a burst abdomen. We found no significant differences in the incidence of inc isional hernias when continuous and interrupted techniques were compared. R etention sutures do not reduce the incidence of incisional hernias. There i s still a need for refinements of the technique of closure of a burst abdom en.