Laparotomy wound dehiscence at Kenyatta National Hospital.

SUMMARY

This is a retrospective study carried out in Kenyatta National Hospital over a 5-year period from June 1996 to May 2001. The broad objective is to determine the magnitude of laparotomy wound dehiscence and determine the causes and outcome following its management. In this period, 2008 laparotomies were done of which 92 had wound disruption. Due to inadequate data 6 were excluded from this study. Thus only 86 (4.3%) were studied

The mortality rate was 2.3 % (2/86) while case mortality for primary laparotomy was 10.5 % (211/2008).

The mean age of the patients was 32 years with age range of 11 to 75years.The male to female ratio was 1:4 (16:70).

Emergency laparotomies accounted for 83% of the cases while 17% were elective procedures.

Abdominal pain, fever, vomiting, coughing and weight loss were the main initial complaints while abdominal tenderness and distension, dehydration and raised temperature were the main physical finding. Anaemia was the main laboratory finding while Human Immunodeficiency Virus (HIV) infection evaluation was inconsistent and thus irrelevant in this study.

Pelvic surgery had the highest incidence of wound disruption (81%) followed by gastrointestinal surgery (15%).

Patients who had vertical incisions were 79, while 7 had transverse incisions. Layered closure was the preferred mode of stitching with catgut being the suture used to close rectus sheath in 71% of the cases (vicryl was used in 23% and nylon in 6% of the cases).

Most wounds dehiscence occurred between sixth to tenth day  (55%) and only 7 % dehisced after fifteenth day.

Infection /peritonitis (40%) and damaged sutures (29%) were the implicated leading causes of wound disruption. In relaparotomy mass closure was the preferred method with or without tension sutures (using nylon No. 1 sutures). The average hospitalisation time was 25 days with a range of 6-153 days. Two patients died; a diabetic female patient whose postoperative haemoglobin was 3.8g/dl and a male patient with spontaneous colonic perforation and had HIV infection.     

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