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Hernia
Published in: Hernia 2/2021

01-04-2021 | Wound Dehiscence | Original Article

Management of abdominal wound dehiscence: update of the literature and meta-analysis

Authors: Andreas Denys, Thomas Monbailliu, Mathias Allaeys, Frederik Berrevoet, Gabriëlle H. van Ramshorst, MD, PhD

Published in: Hernia | Issue 2/2021

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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.
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Metadata
Title
Management of abdominal wound dehiscence: update of the literature and meta-analysis
Authors
Andreas Denys
Thomas Monbailliu
Mathias Allaeys
Frederik Berrevoet
Gabriëlle H. van Ramshorst, MD, PhD
Publication date
01-04-2021
Publisher
Springer Paris
Published in
Hernia / Issue 2/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-020-02294-4

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