Factors affecting primary fascial closure of the open abdomen in the nontrauma patient

Goussous, Naeem; Kim, Brian D.; Jenkins, Donald H.; Zielinski, Martin D.

doi:10.1016/j.surg.2012.07.015

Cited by 43 publications

(35 citation statements)

References 10 publications

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“…17,18 In our series, we observed an equally high rate of closure in patients with nontraumatic etiologies, possibly because we used the ABThera system, which allowed for suctioning of the pelvis, paracolic gutters and subdiaphragmatic spaces. The previous studies used a VAC system, which may not have been able to decontaminate the abdomen as readily and thereby prevented successful primary closure.…”

Section: Discussionmentioning

confidence: 81%

“…In our experience as well as other authors', it is usually apparent 4-7 days after placement of the ABThera that the fascia retracts further and will likely not close with the ABThera alone. 10,17 Although the reason for using an ABRA in addition to the ABThera was not recorded in our series, surgeons typically choose to use the ABRA in patients in whom they feel the fascia is unlikely to close with the ABThera alone. Consequently, we hypothesize that if the ABThera had been used without the ABRA, a primary fascial closure rate of less than 70% would have been observed in these patients.…”

Section: Discussionmentioning

confidence: 91%

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Management of the open abdomen using combination therapy with ABRA and ABThera systems

Mukhi

Minor

2014

Can J Surg

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 91%

Management of the open abdomen using combination therapy with ABRA and ABThera systems

Mukhi

Minor

2014

Can J Surg

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“…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% for the VAC, no statistical difference was due to the above mentioned guidelines and monitoring carried out by the same team of surgeons in all reoperations.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Open abdomen management: single institution experience

Rodrigues

Novo

Arouca

et al. 2015

Rev. Col. Bras. Cir.

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. 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...

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“…Once the therapeutic objective has been achieved, closure of the musculofascial layers should be performed [3,4,[8][9][10] . However, closure of the open abdomen depends on the method used for temporary abdominal wall closure [3,8,9] , the capacity of tissues for healing without tension, and whether or not enteroatmospheric fistulas are present.…”

Section: Intentional (Planned) Acute Poawmentioning

confidence: 99%

“…The capacity of tissues for healing without tension depends on wound-related factors and the patient's general condition [11] . Independently of the technique used for temporary abdominal wall closure, there is a limited window of 2-3 wk to assess early vs delayed closure [8][9][10][11]13,14] . Early definitive closure (final closure of the abdominal defect within the window of 2-3 wk) is based on the resolution of interstitial edema and the evidence of non-adherence between the bowel loops and the abdominal wall.…”

Section: Intentional (Planned) Acute Poawmentioning

confidence: 99%

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

López-Cano

Pereira

Armengol

2013

WJGS

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The so-called "burst abdomen" has been described for many years and is a well-known clinical condition, whereas the concept of the "open abdomen" is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of "acute postoperative open abdominal wall" (acute POAW) is presented, which in turn can be divided into "intentional" or planned acute POAW and "unintentional" or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

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Factors affecting primary fascial closure of the open abdomen in the nontrauma patient

Cited by 43 publications

References 10 publications

Management of the open abdomen using combination therapy with ABRA and ABThera systems

Management of the open abdomen using combination therapy with ABRA and ABThera systems

Open abdomen management: single institution experience

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

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