4.3 Article

Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case-control study

Journal

HERNIA
Volume 27, Issue 2, Pages 353-361

Publisher

SPRINGER
DOI: 10.1007/s10029-022-02719-2

Keywords

Laparotomy; Burst abdomen; Rectus diastasis; Wound healing; Midline hernia

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This study found a significant association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. Rectus diastasis was identified as an important risk factor for burst abdomen after emergency midline laparotomy.
Purpose Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. Methods A single-center, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis. Results A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls; p = < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71-5.47; p = < 0.001). No other suspected risk factors showed a significant association with burst abdomen. Conclusion Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.

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