Recent Therapeutic Alternative Methods for Burst Abdomen and its Relation to Development of Incisional Hernia
Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 73, Issue 1
Abstract
Background: Burst abdomen is considered one of the most challenging obstacles that facing general surgery. Studying the layers of the abdominal wall, and knowing the anatomy of the anterior abdominal wall, its arterial and nerve supply is the corner stone in management of that surgical problem, and in finding the best way how to close that defect. Objective: The aims of the study were to evaluate and compare between recent therapeutic methods of burst abdomen after elective and emergency laparotomy as regard technical, function and to prevent its complication with its later development of incisional hernia. Patients and Methods: This randomized prospective study was carried out at Al-Azhar University Hospitals and Military production hospital on 20 patients with post-lapraotomy burst abdomen in the period from January 2016 to October 2017. The patients were randomly classified according to the method of abdomen closure into 5 groups; 4 patients each: Group A: Closure with TI, TIE, TIES incisions and component separation technique. Group B: Simple mass closure with continuous sutures. Group C: Closure using a Pedicled Tensor Fascia LataFlap. Group D: Vacuum assisted closure. Group E: Closure with gradual skin stretching by tension relief system(TRS). Results: By the use of TI, TIE, TIES incisions and component separation technique, complete fascial closure was achieved in 3 patients (75%).By the use of mass closure, complete fascial closure was achieved in all patients (100%).By the use of the vacuum assisted closure, complete fascial closure was achieved in all patients (100%) but enterocutaneous fistula was encountered in one patient (25%). By the use of the pedicled tensor fascia lata to close the abdomen, complete fascial closure was achieved in all patients (100%) but recurrence occurred in one patient (25%).By the use of the TRS, complete fascial closure was achieved in 2 patients (50%) Conclusion: Mass closure with continous suture seems to be the best method as the abdominal wall defect is not large as its simple ,easy and cost effective .
Authors and Affiliations
Eman Helal
Keywords
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