O32 TREATMENT OF FASCIAL DEHISCENCE IS IMPROVED BY MESH REINFORCEMENT

Aim In 2014 fascial dehiscence (FD) was treated with re-suturing the fascia as the only measure in half of the cases at our institution, with discouraging re-rupture and incisional hernia (IH) rates. A changing path away from fascia closure (FC) by re-suturing solely towards reinforcement of the closed fascia is now evaluated. Material and Methods Retrospective chart review of consecutive patients operated for FD 2016-2020. Available CT scans were scrutinized for IH. Results 58 patients (14 women) with a mean age of 71 years and a mean BMI of 27.3 were treated with: FC by re-suturing as the only measure (n = 1, 1.7%); FC preceded by a reinforced tension line (RTL) suture (n = 9, 15.5%); FC and on-lay mesh reinforcement (n = 23, 39.7%); retromuscular mesh closure (n = 10, 17.2%); open abdomen treatment with retromuscular mesh reconstruction (n = 1, 1.7%); and, open abdomen treatment with vacuum assisted wound closure and permanent on-lay mesh-mediated fascial traction (VAWCPOM) (n = 14, 24.1%). One patient in the RTL-group suffered a re-rupture (1.7%). The in-hospital mortality was 5%. Wound healing problems were seen in 29 (51.9%) patients. IH was evaluable in 49 patients with a total incidence of 22.4% at mean follow-up of 21 months. The hernia incidence for mesh reinforced or reconstructed patients was 17.5% compared to 44.4% in re-sutured or RTL patients. Conclusions FD treatment with mesh reinforced FC prevented re-rupture and resulted in a lower rate of IH. Additional standardization and refining the mesh techniques may further improve results.

Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques

Background Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. Methods We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR. Results We included 504 patients in the analysis, 111 of those suffered from BA. We found intestinal resection (OR 172.510; 22.195–1340.796, p < 0.001), liver cirrhosis (OR 4.788; 2.034–11.269, p < 0.001) and emergency surgery (OR 1.658; 1.050–2.617; p = 0.03) as well as postoperative delirium (OR 5.058; 1.349–18.965, p = 0.016) as the main predictor for developing BA. The main reason for BA was superficial surgical site infection (40.7%). 110 patients received operative revision of the abdominal fascial dehiscence and 108 were eligible for BAR analysis with 14 cases of BAR. Again, post-operative delirium was the patient-related predictor for BAR (OR 13.73; 95% CI 1.812–104-023, p = 0.011). The surgical technique of using interrupted sutures opposed to continuous sutures showed a preventive effect on BAR (OR 0.143, 95% CI 0.026–0,784, p = 0.025). The implantation of an absorbable IPOM mesh did not reduce BAR, but it did reduce the necessity of BAR revision significantly. Conclusion The use of interrupted sutures together with the implantation of an intraabdominal mesh in burst abdomen repair helps to reduce BAR and the need for additional revision surgeries.