Watchful waiting in incisional XXXX : Is it safe?

@entity1 @entity28 @entity260 @entity86 @entity547 @entity34
BACKGROUND: @entity547 ( @entity547 ) is among the most common @entity260 after abdominal surgery. @entity34 ( @entity34 ) using mesh is the treatment of choice. A strategy of watchful waiting (WW) might be a considered in some @entity1 . This retrospective study compares the outcomes of WW and @entity34 . METHODS: All @entity1 presenting with @entity547 in an academic surgery department between January 2004 and December 2009 were analyzed according to whether they were treated by WW or @entity34 . Crossovers between both groups were also analyzed. @entity1 characteristics, information about the initial abdominal operative procedure, symptoms at presentation, and characteristics of the @entity547 were collected retrospectively. In case of @entity260 were analyzed. RESULT: In total, 255 @entity1 were included; 151 (59%) in the @entity34 group and 104 (41%) in WW group. The median follow-up was 68  months (interquartile range [IQR], 52-93). The reasons for WW were the absence of symptoms in 34 @entity1 (33%), comorbidities in 24 (23%), and @entity28 in 23 (22%). During follow-up, 34 @entity1 (33%) crossed over from WW to @entity34 . Eight of the crossovers (24%) were emergency repairs owing to incarceration at a median of 1  month (IQR, 1-5) after the start of WW. The incidence of unexpected intraoperative intestinal perforation was greater in the crossover group (13%) compared with the @entity34 group (2%; P  =  .002). @entity86 were seen in 7% of @entity1 who crossed over from WW to @entity34 versus 0% in primary @entity34 (P  =  .002). Postoperatively, 3 @entity1 died, 2 of whom were treated operatively after belonging initially to the WW group. CONCLUSION: WW for @entity547 leads to high crossover rates with significantly greater incidence of intraoperative perforations, fistulas, and mortality, than in the @entity34 group, particularly in @entity1 who require emergency repair of @entity547 owing to incarceration.
