Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study.
Authors: Hann Michelle J, Mair Tim S, Gardner Alison, Mudge Margaret, Southwood Louise L, Dechant Julie E, Barton Michelle H, Garcia-Macias Jesus, Parker Russell A, Hassel Diana, Archer Debbie C
Journal: Equine veterinary journal
Summary
# Editorial Summary: Acute Abdominal Dehiscence Following Ventral Midline Laparotomy Incisional breakdown remains an underreported but serious threat to horses recovering from abdominal surgery, and this multicentre retrospective analysis of 63 cases across nine hospitals in the UK, Ireland and USA (2009–2019) provides much-needed insight into its presentation and management. The researchers found that acute abdominal dehiscence (AAD) typically manifested around day 5 post-operatively (range 0.5–70 days), with three-quarters of cases (46/63) resulting from suture tearing through the linea alba or adjacent body wall rupture; notably, pregnant and early post-partum mares represented 25% of cases, suggesting particular vulnerability in this population. Surgical site infection preceded AAD in 44% of horses, identifying this as a potential modifiable risk factor worthy of preventative focus during post-operative management. Survival outcomes differed markedly according to intervention: conservative management achieved 90% survival (9/10 horses), whilst surgical repair succeeded in 56% (15/27 horses), with an overall hospital discharge rate of 39%—emphasising the gravity of the complication and the importance of early recognition. For practitioners managing post-operative laparotomy cases, heightened vigilance for signs of infection, fluid leakage or wound breakdown—particularly in broodmares—combined with prompt referral, may prove critical to improving outcomes in this high-morbidity complication.
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Practical Takeaways
- •Monitor post-operative laparotomy patients closely for surgical site infection and signs of dehiscence (particularly within the first 5-10 days), as infection is present in nearly half of AAD cases
- •Pregnant and early post-partum mares carry elevated risk for dehiscence and warrant enhanced post-operative vigilance and management protocols
- •Conservative management may achieve better outcomes than immediate surgical repair in selected cases (90% vs 56% survival), suggesting that treatment decisions should be individualized based on clinical presentation and case-specific factors
Key Findings
- •63 cases of acute abdominal dehiscence occurred at a median of 5 days post-operatively, with 73% due to suture tearing or body wall rupture adjacent to the suture line
- •Surgical site infection developed prior to dehiscence in 44% of cases, and broodmares represented 25% of cases
- •Overall survival to hospital discharge was 39% (24/63), with 56% survival in surgically repaired cases versus 90% in conservatively managed cases
- •Suture repair was the most common surgical technique used (n=14), followed by wire fixation or combination approaches