[Fascia dehiscence--cause and prognosis]

Abstract

During a period of 5 years, 4476 interventions in abdominal surgery were prospectively analyzed. The incidence of fascial dehiscence was 0.7% (n = 30). Seventeen of these patients underwent surgery on account of intraabdominal infection (total incidence of intraabdominal infection 4.4%). Fascial dehiscence developed in 22 out of 30 patients (73%) after emergency surgery. All of them had to be operated out of routine surgical schedule with the exception of four patients. Using multivariate stepwise logistic regression analysis, main determinant factors in fascial dehiscence were the ASA score (p = 0.0001), reflecting the severity of primary or concomitant diseases, and wound infection (p = 0.0075), mostly due to intraabdominal contaminations. Fascial dehiscence was associated significantly with a higher morbidity, reflected by longer inpatient management. Nevertheless, the overall lethality of 20% was associated to serious primary or concomitant diseases. Therefore, the results emphasize the significance of diligent preoperative work-up. Adequate treatment for concomitant disorders should be performed preoperatively, whenever possible even in emergency surgery.