 Post-operative separation of the abdominal musculo-aponeurotic layers.
 Mean time for dehiscence after 8 to 10 days.


 Historical 10%
 Recent study – 3.2% [
Veterens Affairs
Quality programme ]


 Surgery
 Surgeon
 Sutures
 Sepsis
 Straining
 Sick patient


 Grossly contaminated surgery
 Peritonitis
 Biliary-fistula
 Faecal-fistula


 Technique
 Meticulous dissection
 Haemostasis.
 Gentle tissue handling
 Tensionless sutures
 Incision
 Vertical incision worse than
Transverse.


 Violent cough
 Persistent vomiting
 Distension
 Paralytic ileus

 Uncontrolled sepsis

 Sick patient
 Malignancy
 Jaundice
 Obesity
 Anaemia
 Hypo-proteinemia
 Uremia
 Sutures
 Prefer non-absorbable sutures


 Cough
 Anaemia
 Hypo-proteinemia
 Malnutrition
 Steroid

 Post-operative
 Cough
 Abdominal distension
 Ascitis
 Vomiting
 Bowel leakage
 Wound infection
 Haematoma
 Uraemia
 Jaundice
 Electrolyte imbalance

 Range
 9 to 43 %
 Recent study
 16 %
 Prevention is the cornerstone
 With meticulous surgical technique

 Pathognomonic feature
 Sudden rush of copious serosanguinous discharge for the wound
 Large subcutaneous hematoma
 Herniated bowel under the skin
 Tympanic boggy swelling

 Basic principle
 Resuture the wound edges
 Replace the eviscerated organs
 Prevent
 recurrent dehiscence
 Later development of ventral hernias
 As soon as recognized
 Protruding viscera - Warm NS bath
 cover with large sterile dressing
 Shift to OT

 When there is Seepage of serosanguinous fluid through a closed abdominal wound,
 Remove one or two sutures in the skin and
 Explore the wound manually, using a sterile glove .
 Look for any separation of the rectus fascia.

 Operating room for primary closure.
 Wound dehiscence may or may not be associated with intestinal evisceration.
 When evisceration is present, the mortality rate is dramatically increased and may reach 30%.

 If only very small area of the wound disrupted
 That portion alone sutured
 If more than half of the incision disrupted
 Suture whole wound afresh


 Conservative management
 Packing with moist sterile dressing
 Transverse elastic dressing
 Abdominal binder
 Avoid strenous activities
 Secondary suturing/ natural healing

Large deficit:
 NG tube
 GA
 Lift up edges
 Reposition of prolapsed bowel
 Extract fragments of suture
 Freshen the edges
 Retention Suture
 Strong monofilament non-absorbable
 Continuous/ interrupted stitch.

 Strong monofilament Nylon
 Thread through protective rubber tubing
 2.5 cm apart, 2.5 cm from margin.
 All layers of the abdomen taken together.
 Stitch off after 2 to 4 weeks.

Advantage
 Reduce chance of evisceration.
Disadvantage
 Pain, discomfort
 Types
 Internal
 External

GASTROENTEROLOGY 2003;124:1111 –1134