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. 2025 Feb 18;29(1):100.
doi: 10.1007/s10029-025-03279-x.

Short-term outcomes in mesh versus suture-only treatment of burst abdomen: a case-series from a university hospital

Thomas Korgaard Jensen  1   2   3 , Madeline Kvist  4   5 , Merete Berthu Damkjær  4   5 , Jakob Burcharth  4   5   6
Affiliations

Short-term outcomes in mesh versus suture-only treatment of burst abdomen: a case-series from a university hospital

Thomas Korgaard Jensen et al. Hernia. .

Abstract

Purpose: Surgery for a burst abdomen after midline laparotomy is associated with later incisional hernia formation. Accommodating prophylactic measures, notably mesh augmentation, are of interest. However, data regarding safety and outcomes are scarce. This study aimed to evaluate the short-term risk profile of mesh prophylaxis in the context of a burst abdomen.

Methods: This is a single-center prospective study of patients suffering from burst abdomen from 2021 to 2023. A treatment protocol for the management of burst abdomen was introduced, including the synthetic, partially absorbable onlay mesh. Adult patients (≥ 18 years) with a life expectancy of > 1 year with no plans of future pregnancies were recommended to be treated with a prophylactic mesh. In this analysis, adult patients were included if they suffered from a burst abdomen after elective or emergency laparotomy. The study evaluates short-term outcomes, including 90-day wound complications, length of stay, and mortality.

Results: Sixty-seven patients fulfilled the inclusion criteria and underwent treatment for a burst abdomen during the study period. Thirty-eight patients were treated with a suture-only technique, and 29 patients were supplemented with a mesh. 13 of 14 observed wound complications in the mesh group were of mild degree (Clavien Dindo 1-3b), while one patient (3%) needed mesh-explantation. The 90-day mortality rate was 21% and comparable between suture-only and mesh techniques.

Conclusion: Mesh augmentation in surgery for a burst abdomen seems safe in well-selected patients at 90 days follow-up. Long-term data on the prophylactic effect on hernia development is needed.

Keywords: Acute care surgery; Incisional hernia; Laparotomy; Surgical mesh; Surgical outcomes; Surgical wound dehiscence.

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Conflict of interest statement

Declarations. Ethical approval: Approvals The study was approved by the appropriate institutions. Conflict of interest: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Two patients treated for burst abdomen. With large intraabdominal volume and/or loss of fascial domain, intraabdominal draping, mesh-mediated traction (A) and negative pressure therapy (B) was applied to the wound. When fascial closure was possible, mass-closure continuous suturing was used (C). If no contraindications were identified, an on-lay synthetic, partial absorbable mesh was augmented (D)
Fig. 2
Fig. 2
Flowchartof the study population and groups including patients treated consevartively for a burst abdomen (only skin-closure) and patientents with a course of temporaty abdominal closure before fascial closure
Fig. 3
Fig. 3
Specific course and outcomes of the patients treated for burst abdomen with the need of temporary abdominal closure and/or subcutaneous vacuum treatment. Patients not included In the figure: 32 patients in suture-only group and 8 patients in mesh-group with immediate fascial and skin-closure.Sx, Patients within the suture-only group; Mx, Patients within the mesh-group; X, Mesh explantation; D, Death
See this image and copyright information in PMC

References

    1. Jensen TK, Gögenur I, Tolstrup MB (2022) High rate of incisional hernia observed after mass closure of burst abdomen. Hernia 26(5):1267–1274. 10.1007/s10029-021-02523-4 - PubMed
    1. Jensen TK, Gögenur I, Tolstrup M-B (2021) Standardized Surgical primary repair for Burst Abdomen reduces the risk of Fascial Redehiscence. Ann Surg 274(6):e1115–e1118. 10.1097/sla.0000000000003766 - PubMed
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    1. Kvist M, Jensen TK, Snitkjær C, Burcharth J (2024) The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study. Hernia Online Ahead Print. 10.1007/s10029-024-03104-x - PMC - PubMed
    1. Millbourn D, Cengiz Y, Israellson L (2010) Effect of stitch length on wound complications. Arch Surg 145:599. 10.1001/archsurg.2010.78 - PubMed

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