Abdominal wound dehiscence is a severe complication of abdominal surgery in children. Its sudden presentation and requirement of surgical repair in the majority of cases underline the stressful character of this complication for both patients and parents. Reported incidences ranged from 0.4-1.2%, with mortality rates reported as high as 45% [1]. The risk factors for burst abdomen are either patient related or surgery related. Management of this serious complication is a relatively unexplored area in the field of surgery [2].

      A great variety of suture materials and needles have been developed to provide an adequate closure of the fascia and thus the abdominal wall [3]. Therefore the discussion regarding the optimal technique of abdominal fascia closure continues and most surgeons practice according to their own experience [4].

      In this study, I evaluated closing burst abdomen in single muscular layer with multifilament absorbable sutures applied in interrupted manner to see the rate of recurrence of the burst or the development of incisional hernia after closure.

      After approval of the internal review board, fourteen patients with burst abdomen following various abdominal surgeries were collected from pediatric surgery department, Faculty of medicine, Ain shams university in the period between June 2014 and May 2016. Age ranged between five days and six years (mean 3 years, median 3.6 years). The burst occurred 5-10 days after the primary closure (mean 7 days, median 6 days).

      All the burst wounds were closed after debridement of obvious necrotic tissue with interrupted multifilament absorbable sutures in a single muscular layer leaving the skin and subcutaneous tissue to be closed separately, regargdless of the incision done and the technique used in the primary closure (The technique used in the primary closure was closure with multifilament absorbable sutures applied in a continous manner, in one layer in vertical midline incisions and in multiple layers in transverse incisions). We did not irrigate the subcutaneous tissue with saline or antibiotics.

      The patients were followed up for one year after the closure to detect recurrence of the burst or development of incisional hernia.

      Recurrence developed in one patient (7%). This patient had undergone ileostomy and multiple biopsies were taken for intestinal obstruction and suspected Hirschsprung’s disease in the primary operation. The recurrence developed 5 days after the closure. The laboratory tests in the second burst revealed hypoalbuminemia which may be the cause of poor wound healing. The wound was closed, this time, by retention sutures, using non-absorbable material. The patient was fine and was discharged 6 days after the second closure.

      In the remaining thirteen patients, none of them had recurrence. They were discharged 5-8 days after the closure.

      None of the fourteen patients developed incisional hernia during the follow up period.

      Burst abdomen is a serious complication of abdominal surgery and some consider it as an acute postoperative hernia [5]. Multiple techniques have been developed for closing burst abdomen. Abbott et al. reported a 56% success rate when the burst wound was closed primarily with or without retention sutures [6]. Retention sutures are reported to be very painful for the patients and also have been frequently associated with local complications and the need for early removal [7].

      Another technique is closing the burst abdomen with the aid of relaxing incisions. The surgeons did these incisions in the transversus abdominis muscle, the internal oblique muscle, the external oblique muscle and Scarpa’s fascia. Although they reported no recurrence following this technique, the mortality rate was 12.5% [8].

      Research for an effective technique to close a burst abdomen is continuing. Temporary closure using Bogota bag followed by primary closure after one month was tried. However, there was no data to compare this technique with other techniques of closure of burst abdomen [9].

      The use of meshes in closure of burst abdomen was also studied over the past years. Non-absorbable meshes such as polypropylene were associated with enterocutaneous fistula formation and intestinal adhesions. Absorbable meshes such as polyglactin were associated with less complications than nonabsorbable ones but the material can tear resulting in repeat evisceration and the need for reoperation [10,11].

      The technique used in this study was simple. The recurrence rate associated with its use was relatively low (7%). It could be applied for the burst wound regardless of the prescence of wound infection or the technique used in the primary closure.

      However, the number of the patients is small and further studies comparing this technique with other techniques for closing the burst abdomen is necessary to prove its efficacy.

Table 1

Table 1: Summarizes the characteristics of the patients involved in the study.

      Multifilament absorbable interrupted sutures applied in a single muscular layer was a simple technique for closing burst abdomen in children with a relatively low recurrence rate.

      The work has been approved by our ethical committee and subjects gave informed consent to the work.