FACTORS AFFECTING DISRUPTION OF SURGICAL ABDOMINAL INCISIONS IN EARLY POSTOPERATIVE PERIOD

Disruption of abdominal surgical wounds is one of the common causes of early re-laparotomy. Because of high mortality, medical and surgical preventive measures are essantial in primary peri-operative period. Good knowledge of risk factors is mandatory for prophylaxis. In this study we aimed to elucidate some factors contributing to disruption of incisions. In a period of the last 25 years hospital records of 38 cases of abdominal evisceration following major abdominal surgery were analysed retrospectively. Disruption rate is found as 0.92%. Seventy-six percent of 38 patients are men with a mean age of 58 years, and 79% over 50 years of age. Sixty-one percent of primary operations were performed under emergency conditions. Malignant tumours(21%), infectious diseases(21%) and intestinal obstructions(8%) and obstructive jaundice (16%) were the most common primary pathologies as indications of surgery. Wound infection, entero-cutaneous and bilious fistula formation were found as causes affecting wound healing in the postoperative period. Obvious regional and local severe infection is present in 44% of the cases. Two or more factors are contributing to evisceration in great majority (79%) of patients. Mortality was 37% after re-laparotomy for surgical correction of evisceration by support of retention sutures or synthetic mesh. In conclusion, advanced age, The presence of malignancies, jaundice, intraperitoneal infections, disease increasing intraabdominal pressure, and postoperative wound infection and fistula formation were found as factors affecting wound healing process, and leading to evisceration. Early re-laparotomy for correction of evisceration and evisceration itself causes high mortality rate in high risk patients due to primary pathologies and preexisting co-morbid conditions.

ERKEN POSTOPERATÝF DÖNEMDE CERRAHÝ KARIN KESÝLERÝNÝN AÇILMASINDA ETKÝLÝ FAKTÖRLER

Karýn ameliyat yaralarýnýn postoperatif dönemde açýlmasý erken relaparotomi nedenlerinin baþýnda gelmektedir.Yüksek mortalite nedeniyle dikkatler medikal ve cerrahi profilaksi üzerine yoðunlaþmýþtýr. Profilaksinin yöneleceði risk faktörlerinin iyi bilinmesi gerektiðinden araþtýrmamýzda keþi ayrýlmasýna katkýda bulunan faktörlerin aydýnlatýlmasý hedeflenmiþtir. Bu amaçla son 25yýllýk dönemde rastladýðýmýz majör karýn ameliyatlý 38 abdominal evisserasyon olgusunun hastane kayýtlarý retrospektif olarak incelendi. Evisserasyon oraný %0.92'dir. Olgularýn %76'sý erkek, %79'u 50 yaþ üzerinde, ve ortalama yaþ 58'dir. Primer ameliyatlarýn %61'i acil endikasyonludur. Ameliyat gerektiren primer patolojiler incelendiðinde malign tümör (%21), infeksiyöz hastalýklar (%21) ve barsak týkanmalarý (%18), obstrüktif ikter (%16) ön plandadýr. Postoperatif dönemde en sýk karþýlaþýlan yandaþ komplikasyon olarak yan enfeksiyonu ve entero-kutan veya biliyer fistül geliþimi saptanmýþtýr. Olgularýn %44'ünde belirgin bölgesel ve yerel infeksiyon vardýr. Olgularýn %79'unda eviserasyona neden olan iki veya daha çok risk faktörü vardýr. Evisserasyon olgularýmýzda mortalite %37'dir. Sonuçta ileri yaþ ile birlikte, malignite, obstrüktifikter, septik patolojiler, karýn içi basýnç artýþý yaratan patolojilerin mevcudiyeti; yara enfeksiyonu ve fistül geliþimi gibi komplikasyonlar; evisserasyon geliþmesinde etkili olumsuz faktörler olarak bulunmuþtur. Yandaþ sorunlar ve esas cerrahi patoloji nedeniyle yüksek riskli olgularda postoperatif eviserasyon geliþimi yüksek mortaliteye neden olmaktadýr.