Intra-Abdominal Pressure Measurement as Predictor of Postoperative Wound Complications in the Patients Undergoing Emergency Laparotomy: A Prospective Observational Study

Detailed information regarding the patient’s demographics (age, gender, and body mass index), hemodynamic status at admission, and clinical and biochemical evidence of organ failure will be noted. The operative details (intra-operative findings, type of operative procedure, duration of surgery, drain placement, and skin closure method), postoperative diagnosis, and postoperative wound complications (infection, dehiscence, development of incisional hernia) will be recorded. Measurement of intra-abdominal pressure: Non-invasive measurement of IAP in the form of intra-vesicular pressure will be carried out.

Measurement of intra-abdominal pressure: Non-invasive measurement of IAP in the form of intra-vesicular pressure will be carried out. Each patient was catheterised with a 15 Fr Foley catheter and the bladder will be emptied of urine. Then, 50 ml of saline was instilled into the bladder, and the catheter tubing will be clamped. After one minute, intra-vesicular pressure was measured with a saline manometer at full expiration, with the patient lying in the supine position and relaxed abdominal muscles. Zero reference level will be taken at the mid-axillary line level. A conversion factor of 1.36 was used to convert the measured pressure in centimetres into mm Hg. Intra-abdominal pressure will be measured soon after admission, after completion of the operation, and subsequently at an interval of 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours in the postoperative period. The presence of IAH will be categorized into four grades; Grade 1 (lAP 12 - 15 mm Hg), Grade 2 (lAP 16 - 20 mm Hg), Grade 3 (lAP 21- 25 mm Hg) and Grade 4 (lAP > 25 mm Hg) as per WSACS guideline. The acute physiology and chronic health evaluation (APACHE) ll score will be calculated at the time of admission and 72 hours after laparotomy in all the patients. The abdominal wound complications will be identified according to guidelines recommended by the Centre for Disease Control and Prevention (CDC) for diagnosis of surgical site infections. Wound infection or superficial surgical site infection will be considered when the depth of infection will be confined to the skin, and subcutaneous tissue and wound dehiscence are defined as the separation of the abdominal musculoaponeurotic layers. Complete epithelisation in open wounds and the absence of signs of dehiscence after suture removal in sutured wounds will be considered adequate wound healing. The patients will be discharged when their oral feeding will be considered sufficient to meet daily nutritional requirements, the absence of fever for 48 hours, and a healing abdominal wound can be managed at the residence of the patient. Epithelialization is an essential component of wound healing used as a defining parameter of its success. ln the absence of re-epithelialization, a wound cannot be considered healed.