UNINTENTIONAL POST-OPERATIVE OPEN ABDOMINAL WALL IN NON-TRAUMATIC PATIENTS: A MONOCENTRIC RETROSPECTIVE STUDY IN TUNISIA

Abstract

Introduction:  Unintentional post-operative open abdominal wall (UPOAW) is a postoperative complication that consists of the early separation of the fascial layer after a primary closure of a laparotomy incision. This complication is associated with great morbidity and mortality. In this article, we studied the frequency of some of these known factors in our series and we briefly discussed the management of this complication. Methods:  It was a monocentric retrospective and descriptive study. We enrolled patients with UPOAW, admitted in the department of surgery in Habib Thameur hospital in Tunis (Tunisia), between January 2010 and December 2015.We did not include traumatic patients. We excluded patients with missing data from medical records. Results:  The study was conducted on fifteen patients. Eight out of fifteen were men. Patients were aged between 41 and 76 years, with a mean age of 66.6 ± 11.4 years. In the past medical history, chronic obstructive pulmonary disease was noted in three patients, cirrhosis in three patients, diabetes in one patient and a history for laparotomy in one patient. Eight out of fifteen underwent emergent surgeries. Two out of these eight patients had haemodynamic instability throughout surgery. In the postoperative course, coughing was noted in three patients, abdominal distension from ileus in three patients, vigorous postoperative ventilation in two patients and vomiting in one patient. UPOAW was diagnosed between postoperative day zero and postoperative day twenty-one, with a mean time of diagnosis of 10.1 ± 6.6. All patients had immediate closure of the fascial layer. The surgeon used retro-fascial polyglactin mesh in three patients. Relaxing incisions were used in 5 patients. Morbidity after reoperation was 46.7 % (7/15) and mortality was 33.3 % (5/15). Conclusion:  UPOAW is a serious complication with high morbidity and mortality. Many factors can contribute to this complication. Every visceral surgeon is confronted with this problem at some point of his carrier and should apply the adequate treatment to his patients depending on his decision and experience. Strong level of evidence is needed to establish clear guidelines for the management of this heterogenous complication.