INTRODUCTIONExploratory laparotomy whether elective or emergency has always remained one of the common operations across the surgical disciplines. The closure of such a laparotomy wound is key to reduce the post-operative morbidity like wound pain, wound infections and incisional hernias.1 Wound dehiscence carries with it a substantial morbidity and mortality. Mortality associated with burst abdomen has been estimated at 16%.2 The mean time for wound dehiscence is 8-10 days after operation.2,3 Abdominal wound dehiscence is a common complication of emergency laparotomies in Indian setup.Wound dehiscence is related to technique of closure of abdomen. Many patients in India have poor nutritional status and the presentation of patients with peritonitis is often delayed. This makes the problem of wound dehiscence more common in Indian setup.4 Post-operative complete wound dehiscence is a very serious complication associated with high morbidity and mortality. 5 The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. To date, various randomised clinical trials and meta-analysis have been published with heterogeneous results. While the choice may not be so important in elective patients who are nutritionally ABSTRACT Background: Abdominal wound closure technique should be efficient to perform, provide strength and be a barrier to infection. The method of closure of the abdominal wall is a critical aspect of an effective incision closure, in addition to the choice of suture material. Abdominal wound dehiscence is a common complication of emergency laparotomy. This study was done to know whether our method of abdominal closure was helpful in reducing incidence of burst abdomen. Methods: This retrospective study was carried out in the department of general surgery in a tertiary medical centre in Mumbai. 126 Patients undergoing emergency laparotomies for extensive generalised peritonitis through a vertical midline incision were included in this study; the indications for laparotomy were inflammatory, traumatic and neoplastic. Results: Out of 126 patients undergoing closure of laparotomy wound by our method, wound infection was noted in 12 (9.52%) cases and 3 (2.38%) patients developed wound dehiscence (burst abdomen). Conclusions: This retrospective study demonstrates that our method of abdominal closure was helpful in reducing the incidence of burst abdomen post-operatively. This is of extreme clinical importance in reducing morbidity, mortality and healthcare cost related to abdominal wound dehiscence in a patient undergoing emergency laparotomy.
Introduction Many patients are admitted to hospitals as destitute or unknown, after having met with accidents. What happens to these patients after admission is not much reported in world literature. With the ever increasing number of road traffic accidents (RTAs), a significant number of such patients are reported worldwide.
Material and Methods We conducted a retrospective analysis of the departmental case records of destitute patients from January 2009 till December 2018 in our institute. The mode of presentation, demographic profile, computed tomography scan findings, hospital course, and outcome at discharge were analyzed.
Results Out of 128 patients, there were 114 (89.1%) male patients, maximum being in the 21 to 30 years age group. The mean age was 36.4 years with ages ranging from 10 to 70 years. The average length of stay in hospital was of approximately 6 days with maximum being 37 days. The main cause of head injury was RTA in 66 patients (51.5%). Majority, that is, 84 patients, had a Glasgow Coma Scale score of < 8 at admission. Forty-two head injury patients were operated in all, while the rest were managed conservatively. Forty-nine (38.2%) patients died in hospital, and 44 (34.3%) patients had good recovery. During treatment, 16 (12.5%) patients took discharge against medical advice, while identity of 63 (49.2%) patients could be established out of which 5 (3.9%) patients were either discharged to home while 51 (39.8%) patients were referred to their district hospital. Two patients (1.5%) remained unknown and were sent to destitute homes for rehabilitation.
Conclusion Unknown head injury patients are usually neglected and their outcome is poorer in comparison to other patients. Their management is fraught with challenges. They need special care for which staff should be well trained and hospital must have economic resources and a good network of social workers.
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