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Evisceration and Dehiscence

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Abstract

Dehiscence of the abdominal wound, causing a defect in the fascia, is a complication with high morbidity and mortality rates of up to 35 %. The incidence of dehiscence, or burst abdomen, has been reported to lie between 0.2 and 3.5 %. Reported risk factors for dehiscence include surgical site infection, advanced age, male gender, chronic obstructive lung disease, anemia, and type of surgical procedure. In some cases dehiscence can be treated conservatively, with a potential incisional hernia repair planned for the future. Evisceration of abdominal contents, which can occur in dehiscence, usually necessitates more aggressive treatment decisions. Operative treatment options include resuturing of the abdominal wall with or without releasing incisions, staged closure with mesh advancement with or without negative pressure wound therapy, or closure with biological meshes. In general, closure without mesh results in high rates of incisional hernia of up to 83 %. Staged mesh advancement seems to result into lower rates of incisional hernia. If incisional hernia does occur, defects are usually smaller in size. Patients who survive abdominal wall dehiscence report low scores for cosmesis and body image. Also, lower scores are reported for physical and mental components of quality of life questionnaires compared to control patients.

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  1. Department of Surgery, VU University Medical Center, ZH 7F05, 7057, 1007 MB, Amsterdam, The Netherlands

    Gabriëlle H. van Ramshorst M.D., Ph.D.

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  1. Gabriëlle H. van Ramshorst M.D., Ph.D.
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Correspondence to Gabriëlle H. van Ramshorst M.D., Ph.D. .

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  1. Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA

    William W. Hope

  2. USC School of Medicine-Greenville, Greenville Health System, Greenville, North Carolina, USA

    William S. Cobb

  3. Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Gina L. Adrales

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van Ramshorst, G.H. (2017). Evisceration and Dehiscence. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_42

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