Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Chen, Yu; Ye, Jinning; Wu, Song; Chen, Jianhui; Yuan, Yujie; Ren, Jianan

doi:10.1155/2014/784056

Cited by 56 publications

(64 citation statements)

References 53 publications

(56 reference statements)

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“…A systematic review and meta-analysis to evaluate whether early fascial abdominal closure had advantages over delayed approach was published in 2014 [ 48 ]. Mortality, complications, and length of stay were compared between early and delayed fascial closure.…”

Section: Management Of Patients With Open Abdomenmentioning

confidence: 99%

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

et al. 2015

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The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear.In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal.However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias.Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

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Section: Management Of Patients With Open Abdomenmentioning

confidence: 99%

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

et al. 2015

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“…44 Early fascial closure has been associated with improved outcomes for patients with the open abdomen. A metaanalysis 45 revealed lower mortality (P < .001) and fewer complications (P < .001) in patients in whom early fascial closure was achieved within 4 to 7 days of the initial laparotomy. IAP is monitored closely during and after the closure procedure.…”

Section: Closure Of the Open Abdomenmentioning

confidence: 99%

Open Abdomen in Trauma and Critical Care

Fitzpatrick

2017

Critical Care Nurse

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The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this poten- T he open abdomen is a technique with recently expanded implementation in managing complex problems in critically ill patients. First used in trauma care in the 1990s, the technique is now a management strategy for many other illnesses and conditions in critically ill adults. The mainstay of treatment for intra-abdominal infections, intra-abdominal bleeding, and abdominal compartment syndrome (ACS), whatever the cause, is the intentional creation of an open abdomen, which is a laparotomy wound that allows a damaged or edematous viscera to expand, reducing intra-abdominal pressure (IAP) and related complications.1 The technique of the open abdomen is defi ned as intentionally leaving the fascial edges of the abdomen unapproximated (laparostomy) through a surgically created entrance into the cavity. As a result, the abdominal contents are exposed but are protected by a temporary 22

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“…PFC is the most commonly primary outcome measure because it is reported to significantly reduce complication and mortality rates in the cases with early PFC, irrespectively of the technique for TAC (9). Although most systematic reviews reported preponderance of NPWT, the most recent meta-analysis of only comparative studies reported similar PFC rate in NPWT vs non-NPWT with significant heterogeneity between included studies (2).…”

Section: Primary Fascial Closurementioning

confidence: 99%

The open abdomen - still a challenge for the surgeons. Which is the best technique for temporary abdominal closure? A focus on negative pressure wound therapy

Popivanov¹,

Kjossev²,

Mutafchiyski³

2017

GHIR

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Brief overview The open abdomen (OA) is not a new idea. In 1897 Andrew McCosh describe its use in diffuse peritonitis, in 1894 Körte used it in necrotic pancreatitis. In 1940 the military surgeon W.H. Ogilvie reported two cases in which he left abdomen open. In the middle of XX century Gross and Schuster used it in the treatment of large omphalocele in children. Nowadays, there is consensus about the indication for OA-severe diffuse peritonitis with insufficient control of the primary source of infection, damage control surgery in trauma, abdominal compartment syndrome, need for second look. Various technique for temporary abdominal closure (TAC) have been described which clearly indicates that the ideal technique is not yet available. These are open packing, skin closure with towel clips, Bogota bag, mesh, mesh-zipper, mesh-foil (Figure 1), palisade dorsoventral drainage (Figure 2), Wittmann patch, negative pressure wound therapy. During the years TAC ® evolved from a passive dressing to active approach with negative pressure. In 1986 M. Schein published in BJS the so-called "sandwich technique" which is the first use of negative pressure in open abdomen (1). After 1994 negative pressure wound therapy (NPWT, home-made or commercial vacuum assisted closure) have gained tremendous popularity. Along with traditional home made Barker's vacuum pack several commercial products have been released into the practice: V.A.C. ® (KCI), Vivano ® (Hartmann), Renasys ® (Smith & Nephew). Actually, the pioneers from Wake Forest University in North Carolina replaced the gauze with polyurethane foam in 1996. Despite the growing body of literature high level of evidence about open abdomen management are still lacking (2). This is may be due to the inherent difficulties to perform randomized controlled trial in emergency setting. The following advantages in comparison to passive dressings has been claimed: increased primary fascial closure, lower rate of adhesions, diminished bacterial count, better qualitative and quantitative analysis of the fluid, increased survival and significantly easier nursing. The critical analysis, however, revealed significantly more complicated situation. Recent systematic review and meta-analysis of only comparative

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Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Cited by 56 publications

References 53 publications

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper

Open Abdomen in Trauma and Critical Care

The open abdomen - still a challenge for the surgeons. Which is the best technique for temporary abdominal closure? A focus on negative pressure wound therapy

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