Management of abdominal wound dehiscence: update of the literature and meta-analysis
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ORIGINAL ARTICLE
Management of abdominal wound dehiscence: update of the literature and meta‑analysis Andreas Denys1 · Thomas Monbailliu2 · Mathias Allaeys2 · Frederik Berrevoet2 · Gabriëlle H. van Ramshorst1 Received: 21 June 2020 / Accepted: 27 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Abdominal wound dehiscence (AWD) is associated with significant morbidity and mortality. We aimed to provide a contemporary overview of management strategies for AWD. Methods PubMed, EMBASE, the Cochrane library and a clinical trials registry were searched from 2009 onwards using the key words “abdominal wound dehiscence”, “fascial dehiscence” and “burst abdomen”. Study outcomes included surgical site infection (SSI), recurrence, incisional hernia and 30-day mortality. Studies reported by the EHS clinical guidelines on AWD were included and compared with. OpenMetaAnalyst was used for meta-analysis to calculate statistical significance and odds ratios (OR). Results Nineteen studies were included reporting on a total of 632 patients: 16 retrospective studies, one early terminated randomized controlled trial, one review and the European Hernia Society guidelines. Nine studies reported use of synthetic mesh (n = 241), two of which used vacuum-assisted mesh-mediated fascial traction (VAWCM) (n = 19), six without VAWCM (n = 198) and one used synthetic mesh with both VAWCM (n = 6) and without VAWCM (n = 18); two used biological mesh (n = 19). Seven studies reported primary suture closure (n = 299). Three studies reported on an alternative method (n = 91). Follow-up ranged between 1 and 96 months. Meta-analysis was performed to compare the primary suture group with the synthetic mesh group. Heterogeneity was low to moderate depending on outcome. The overall SSI rate in the primary suture group was 27.6% versus 27.9% in the synthetic mesh group, resulting in mesh explantation in five patients; OR 0.65 (95% CI 0.23–1.81). Incisional hernia rates were 11.1% in the synthetic mesh group (19/171) and 30.7% in the primary suture group (67/218); OR 4.01 (95% CI 1.70–9.46). Recurrence rate did not show a statistically significant difference at 2.7% in the synthetic mesh group (3/112), compared to 10.2% in the primary suture group (21/206); OR 1.81 (95% CI 0.18–17.80). Mortality rates varied between 11.2% and 16.7% for primary suture group versus synthetic mesh; OR 1.85 (95% CI 0.91–3.76). Conclusion Included studies were of low to very low quality. The use of synthetic mesh results in a significantly lower rate of incisional hernia, whereas SSI rate was comparable to primary suture repair.
Introduction Abdominal wound dehiscence (AWD) is a serious postoperative complication associated with significant morbidity and mortality. The incidence of AWD ranges between 2% and This abstract was selected for oral presentation at the European Hernia Society meeting in Barcelona in May 2020. * Gabriëlle H. van Ramshorst [email protected] 1
Department of Gastrointestinal Surgery, Ghent University H
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