Open abdomen management: single institution experience

Abstract

. Today, despite advances in AA use with the development of vacuum therapy, the Bogota Stock Exchange (BB) is still widely used. In our institution and throughout Brazil, both techniques are used and the study's goal is to evaluate the morbidity and the result of the integrity of the abdominal wall after the use of both techniques. METHODS METHODS METHODS METHODS METHODSA retrospective study was conducted at HCFMUSP, identifying patients undergoing temporary abdominal closure (FAT) between January 2005 and December 2011. Data were collected through review of medical records. Data were compared in patients undergoing treatment with assisted closing the vacuum and the Bogota bag.Inclusion criteria were temporary abdominal closure indication survival and the definitive abdominal closure. FAT indications included: abdominal trauma, severe abdominal sepsis and ACS. Data collected included age, FAT indication, the number of procedures in the operating room and the primary fascial closure rate. In the postoperative period, one group of three surgeons followed all patients and performed all reoperations. As soon as possible, the aponeurosis of the edges were subjected to progressive approach with careful not to cause abdominal hypertension.The demographics of the two study groups (BB and VAC) were compared using the chi-square test of Pearson or Fisher's exact test for categorical variables and the Student t test for continuous variables. RESULTS RESULTS RESULTS RESULTS RESULTSDuring the study period, 59 patients require some kind of temporary abdominal closure (FAT), however, only 29 patients survived the final abdominal closure (52.5% mortality). One patient was excluded (subject to closure Backaus forceps). Thus, 28 patients were included, and, after two years of follow-up, none of them developed abdominal hernia or intestinal fistulas.There was no statistical difference between the study groups with respect to age (p> 0.05) and a significant difference regarding indications for temporary abdominal closure (p <0.05) ( Table 1).The primary closure rates were similar in both groups (p = 0.98). The average time (days) for fascial closure was 10.8 days for the BB group and 7.52 days in the group VAC (Table 2). DISCUSSION DISCUSSION DISCUSSION DISCUSSION DISCUSSIONIn this study, there was no statistical difference between the closing assisted vacuum and the Bogota bag (VAC and BB) when analyzed the number of operations, the primary closure, and the average time of closing. However, a previous study 19 showed better results when using VAC BB was compared on the primary closure (50 to 70 %% and 88% for BB VAC). The best approach to achieve the definitive abdominal closure in patients with open abdomen remains controversial. To improve the fascial closure rate, the excess volume resuscitation should be avoided, the water balance should be carefully implemented, not only on admission, but also throughout the course of treatment with open abdomen 20 . The high rate of primary closure found in our patients, 80% for BB and 96% f...

Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report

“…In our case, vacuum-assisted closure (VAC) was used. This technique enables draining the peritoneal fluid, minimizes visceral edema and applies greater fascial tension to the abdominal wall, thereby increasing the odds of a definite abdominal closure without the formation of hernias or major defects [ 11 ].…”

Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction) treatment manual for temporary abdominal wall closure – results of 58 consecutive patients

“…The patients who underwent VACM therapy in our department had a high mortality rate of 45.2%. However, the relevant literature also indicates mortality rates >30% for patients with open abdomen and TAC [ 2 ], in individual cases mortality rates >50% have been described [ 19 ]. Mortality is particularly high in patient groups with secondary peritonitis: in a prospective study by Fortelny et al [ 20 ] which only included patients with a septic intraabdominal focus it was even 55.2%.…”

Intra-abdominal hypertension secondary to chronic diaphragmatic rupture in a dog

“…Based on FELICIANO & GAONA (2018), TAC was the selected procedure in this report, as primary closure of the abdominal wall was not possible due to the pressure on the intraabdominal tissues, where abdominal tension was observed macroscopically upon approaching the abdominal muscles. RODRIGUES JUNIOR et al (2015) maintain that the methods for TAC should promote containment of the abdominal viscera, limit contamination, inhibit adhesions and damage to the abdominal wall, and prevent ACS in humans. In this case, the Bogota bag, as recommended by FELICIANO & GAONA (2018), was selected for the temporary closure.…”

“…APP is the difference between the MAP and the IAP (MALBRAIN et al, 2006); thus, when the IAP increases, there is a decrease in the APP (MALBRAIN et al, 2006), which can lead to the deterioration of visceral circulation and liver function (ELATROUSH et al, 2015). According to RODRIGUES JUNIOR et al (2015), the decrease in IAP and the patient's clinical progress should be taken into account when definitive abdominal closure is to be performed on human patients. In this report, a definitive closure was performed 24 hours after TAC, as the animal met the clinical parameters and its APP and IAP were within the reference range for the species.…”