Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study
Purpose Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. Methods A single-center, retrospective, matched case–control study o...
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| Veröffentlicht in: | Hernia : the journal of hernias and abdominal wall surgery 2023-04, Vol.27 (2), p.353-361 |
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| creator | Kvist, M. Henriksen, N. A. Burcharth, J. Nielsen, Y. W. Jensen, T. K. |
| description | Purpose
Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy.
Methods
A single-center, retrospective, matched case–control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis.
Results
A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls;
p
= |
| doi_str_mv | 10.1007/s10029-022-02719-2 |
| format | Article |
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Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy.
Methods
A single-center, retrospective, matched case–control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis.
Results
A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls;
p
= < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71–5.47;
p
= < 0.001). No other suspected risk factors showed a significant association with burst abdomen.
Conclusion
Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.</description><identifier>ISSN: 1248-9204</identifier><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-022-02719-2</identifier><identifier>PMID: 36422726</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdomen ; Abdomen - surgery ; Abdominal Surgery ; Case-Control Studies ; Cirrhosis ; Herniorrhaphy ; Humans ; Laparotomy ; Laparotomy - adverse effects ; Medicine ; Medicine & Public Health ; Multivariate analysis ; Muscles ; Original Article ; Rectus Abdominis - surgery ; Retrospective Studies ; Risk factors ; Suture Techniques ; Sutures ; Umbilicus</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2023-04, Vol.27 (2), p.353-361</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-142fd3bfb5226b3f30f68466c80a169325fa8ccd64037e688a034b8137f3cd963</citedby><cites>FETCH-LOGICAL-c375t-142fd3bfb5226b3f30f68466c80a169325fa8ccd64037e688a034b8137f3cd963</cites><orcidid>0000-0002-2651-2771 ; 0000-0002-1805-9866 ; 0000-0001-8367-7831 ; 0000-0001-9589-0955 ; 0000-0002-5060-1352</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10029-022-02719-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10029-022-02719-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36422726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kvist, M.</creatorcontrib><creatorcontrib>Henriksen, N. A.</creatorcontrib><creatorcontrib>Burcharth, J.</creatorcontrib><creatorcontrib>Nielsen, Y. W.</creatorcontrib><creatorcontrib>Jensen, T. K.</creatorcontrib><title>Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Purpose
Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy.
Methods
A single-center, retrospective, matched case–control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis.
Results
A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls;
p
= < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71–5.47;
p
= < 0.001). No other suspected risk factors showed a significant association with burst abdomen.
Conclusion
Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.</description><subject>Abdomen</subject><subject>Abdomen - surgery</subject><subject>Abdominal Surgery</subject><subject>Case-Control Studies</subject><subject>Cirrhosis</subject><subject>Herniorrhaphy</subject><subject>Humans</subject><subject>Laparotomy</subject><subject>Laparotomy - adverse effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate analysis</subject><subject>Muscles</subject><subject>Original Article</subject><subject>Rectus Abdominis - surgery</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Suture Techniques</subject><subject>Sutures</subject><subject>Umbilicus</subject><issn>1248-9204</issn><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi0EoqXwAiyQJTZsQp2xYzvsUFUuUiUkBGvL8aW4JPHB4yzOjnfoG_IkNZxyURcsfJHmm39G-gh52rOXPWPqFNsNY8cA2lH92ME9ctyD0N0ITNz_539EHiFeMca0kPohOeJSACiQx6R8DK5uSH2yWC0mpGl1JVgMSEvCrzRHOm0FK7WTz0tYW52GJZTLsLo9XZKf0xrobHe25JqXFPAVtXSx1X0JnroW9OP7tctrLXmmWDe_f0weRDtjeHL7npDPb84_nb3rLj68fX_2-qJzXA216wVEz6c4DQBy4pGzKNv60mlmezlyGKLVznkpGFdBam0ZF5PuuYrc-VHyE_LikLsr-dsWsJoloQvzbNeQNzSg-KgEE4Nq6PM76FXeytq2M6DZAJpLNjQKDpQrGbGEaHYlLbbsTc_MTyPmYMQ0I-aXEQOt6dlt9DYtwf9p-a2gAfwAYCutl6H8nf2f2BthNZfD</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Kvist, M.</creator><creator>Henriksen, N. 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A. ; Burcharth, J. ; Nielsen, Y. W. ; Jensen, T. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-142fd3bfb5226b3f30f68466c80a169325fa8ccd64037e688a034b8137f3cd963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdomen</topic><topic>Abdomen - surgery</topic><topic>Abdominal Surgery</topic><topic>Case-Control Studies</topic><topic>Cirrhosis</topic><topic>Herniorrhaphy</topic><topic>Humans</topic><topic>Laparotomy</topic><topic>Laparotomy - adverse effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate analysis</topic><topic>Muscles</topic><topic>Original Article</topic><topic>Rectus Abdominis - surgery</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Suture Techniques</topic><topic>Sutures</topic><topic>Umbilicus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kvist, M.</creatorcontrib><creatorcontrib>Henriksen, N. A.</creatorcontrib><creatorcontrib>Burcharth, J.</creatorcontrib><creatorcontrib>Nielsen, Y. W.</creatorcontrib><creatorcontrib>Jensen, T. 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A.</au><au>Burcharth, J.</au><au>Nielsen, Y. W.</au><au>Jensen, T. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>27</volume><issue>2</issue><spage>353</spage><epage>361</epage><pages>353-361</pages><issn>1248-9204</issn><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Purpose
Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy.
Methods
A single-center, retrospective, matched case–control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis.
Results
A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls;
p
= < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71–5.47;
p
= < 0.001). No other suspected risk factors showed a significant association with burst abdomen.
Conclusion
Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>36422726</pmid><doi>10.1007/s10029-022-02719-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2651-2771</orcidid><orcidid>https://orcid.org/0000-0002-1805-9866</orcidid><orcidid>https://orcid.org/0000-0001-8367-7831</orcidid><orcidid>https://orcid.org/0000-0001-9589-0955</orcidid><orcidid>https://orcid.org/0000-0002-5060-1352</orcidid></addata></record> |
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| subjects | Abdomen Abdomen - surgery Abdominal Surgery Case-Control Studies Cirrhosis Herniorrhaphy Humans Laparotomy Laparotomy - adverse effects Medicine Medicine & Public Health Multivariate analysis Muscles Original Article Rectus Abdominis - surgery Retrospective Studies Risk factors Suture Techniques Sutures Umbilicus |
| title | Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study |
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