Fascial Dehiscence Despite Declared Adoption of European Hernia society guidelines: A retrospective study following laparotomy.

PURPOSE: Abdominal fascial dehiscence is a serious postoperative complication following laparotomy, associated with high morbidity and mortality. Although the small-bite technique is recommended by the European Hernia Society, its implementation in clinical practice, particularly in emergency surgery, remains uncertain. This study described documented fascial closure practices among patients with fascial dehiscence following laparotomy and characterised patient-related and technical features within this cohort.

METHODS

This retrospective study included all patients who developed fascial dehiscence following laparotomy at two surgical departments in the North Denmark Region between 1 March 2021 and 1 March 2026. Data on demographics, comorbidities, operative characteristics, closure technique, and postoperative outcomes were collected from medical records and analysed using descriptive statistics.

RESULTS

A total of 81 patients were included. Most underwent acute laparotomy (74.1%), and 66.7% were classified as ASA score ≥ III. The declared small-bite technique was documented in 67.9% of cases, while conventional large-bite suturing was not recorded in any patient. Suture-to-wound length ratio was documented in only 2 patients (2.5%), both achieving a ratio of 4:1. Median time to dehiscence was 7 days (IQR 4-10), and reoperation was performed in 97.5% of patients. Management strategies at reoperation varied considerably, most commonly VAC therapy (46.9%) and small-bite re-suturing (43.2%), while conventional large-bite repair, absent at primary closure, was used in 6.2% of cases. The Clavien-Dindo distribution was bimodal (40.7% Grade I, 40.7% Grade IIIb), and 90-day mortality was 12.3%.

CONCLUSION

The declared small-bite technique was the predominant documented closure method among patients who developed fascial dehiscence. The high prevalence of emergency surgery and comorbidity in this cohort may suggest that patient-related and physiological factors contribute substantially to this complication. Near-universal absence of suture-to-wound length ratio documentation precludes firm conclusions regarding true guideline compliance, while marked heterogeneity in reoperative closure reflects a lack of evidence-based guidance. Improving documentation standards and directing future research toward high risk, emergency populations represent key priorities.