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Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study

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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.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark

    M. Kvist, J. Burcharth & T. K. Jensen

  2. Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark

    M. Kvist, N. A. Henriksen, J. Burcharth & T. K. Jensen

  3. Department of Radiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark

    Y. W. Nielsen

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  1. M. Kvist
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  2. N. A. Henriksen
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  3. J. Burcharth
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  4. Y. W. Nielsen
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Contributions

MK, NAH, JB and TKJ contributed to the study conception and design. Material preparation, data collection and analysis were performed by MK, YWN and TKJ. The first draft of the manuscript was written by MK. All authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to M. Kvist.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. This research project was approved by the Danish Data Protection Agency (HGH-2016- 03) and the Danish Patient Safety Authority (31-1521-382). The National Committee on Health Research Ethics assessed that no approval was needed (H-20034185).

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Informed consent was not required due to the retrospective nature of the study.

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No animals were used for this study.

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Kvist, M., Henriksen, N.A., Burcharth, J. et al. Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study. Hernia 27, 353–361 (2023). https://doi.org/10.1007/s10029-022-02719-2

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