Comparative study of abdominal cavity temporary closure techniques for damage control

Abstract

The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity. RESUMO A cirurgia de controle de danos, com ênfase em peritoneostomia, geralmente resulta em retração da aponeurose e perda da capacidade de fechar a parede abdominal, levando à formação de hérnias ventrais incisionais. Atualmente, várias técnicas oferecem maiores chances de fechamento da cavidade abdominal, com menor tensão. Deste modo, este estudo tem por objetivo avaliar três técnicas de fechamento temporário da cavidade abdominal: fechamento a vácuo (Vacuum-Assisted Closure Therapy - VAC), Bolsa de Bogotá e Vacuum-pack. Realizou-se uma revisão sistemática da literatura com seleção de 28 artigos publicados nos últimos 20 anos. As técnicas de Bolsa de Bogotá e Vacuum-pack tiveram como vantagem o acesso fácil ao material, na maioria dos centros, e baixo custo, ao contrário do que se observa na terapia a vácuo, VAC, que além de apresentar alto custo, não está disponível em grande parte dos hospitais. A técnica VAC, por outro lado, foi mais eficaz na redução da tensão nas bordas das lesões, ao remover fluidos estagnados e detritos, além de exercer ação a nível celular, aumentando as taxas de proliferação e divisão celular, e apresentou as maiores taxas de fechamento primário da cavidade abdominal.

Managing the Open Abdomen in Damage Control Surgery: Should Skin-Only Closure be Abandoned?

“…The cytokine milieu of wounds changes in response to negative pressure. Increased levels of vascular endothelial growth factor and interleukin-8 are observed, which promotes angiogenesis and chemoattracts neutrophils [ 46 ].…”

Non‐healing wounds: Can it take different diagnosis?

“…With the vacuum‐assisted closure system, partial oxygen pressure in tissues increases and bacterial growth is reduced. In addition, it provides a local interleukin‐8 and vascular endothelial growth factor increase that may cause the accumulation of neutrophils and angiogenesis …”

“…In addition, it provides a local interleukin-8 and vascular endothelial growth factor increase that may cause the accumulation of neutrophils and angiogenesis. 11 In non-healing wounds, foreign bodies can be diagnosed in the postoperative period owing to pain, infection, palpable mass, or during radiological imaging. Computed tomography is generally used in patients with suspected foreign bodies.…”

Damage Control Surgery and Management of Open Abdomen

“…İntraabdominal basınç artışıyla karakterize abdominal kompartman sendromu (AKS) tedavisi sırasında, karın içi basınç artışının önüne geçmek için açık karın yönetimine geçil-mesi abdominal sepsisli, multitravmalı veya ağır akut pankreatitli hastalardaki en uygun tedavi şekli olmuş-tur (13)(14)(15)(16)(17) . Özellikle son birkaç dekattır ortaya çıkmış olan hasar kontrol cerrahisi gereksinimi olan masif hemorajili, ağır sepsisli, akut mezenterik iskemili hastalarda bağırsakların beslenme durumunu görmek isteği, yapılmış olan anastomozun durumunu takip etme dür-tüsü ya da pürülan özellikte peritoneal mayinin batının defalarca irigasyonuyla dışarı alınması ve bunu takip etme isteği bu yöntemin yeğlenmesine temel teşkil eden düşüncelerdir (18,19) . Geçici batın kapama işlemi yapılmasına karar verilen hastalarda daha başlangıçta bu hastaların batınlarının ne zaman ve nasıl kapatılabi-leceği de düşünülmeye başlanmalıdır.…”