Long-Term Vacuum-Assisted Closure in Open Abdomen due to Secondary Peritonitis: A Retrospective Evaluation of a Selected Group of Patients

Abstract

Background/Aims: Vacuum-assisted closure (VAC) leads to a high fascial closure rate in open abdomen within the first week of treatment. However, little data exist on the role of long-term VAC treatment in patients with peritonitis, where fascial closure cannot be accomplished within the first days. Methods: We reviewed the medical records of 49 patients with open abdomen for more than 7 days due to secondary peritonitis, who underwent a VAC-treatment. Nonparametric analysis was performed using χ² test or Fisher’s exact test. Results: Fascial closure could be accomplished in only 11 patients (22%), whereas complications occurred in 43 patients (88%). Re-explorations after starting VAC were associated with the occurrence of enterocutaneous fistula (p < 0.001) and were also of prognostic value regarding the rate of fascial closure (p = 0.033). Conclusions: If fascial closure cannot be accomplished within the first days, patients show a dramatically lower fascial closure and an increased complication rate with VAC. Further studies are needed to evaluate whether this subgroup really benefits from VAC.

Systematic review and evidence based recommendations for the use of Negative Pressure Wound Therapy in the open abdomen

“…The promotion of granulation tissue by NPWT is widely reported in other indications however direct extrapolation of this data to the specific indication of open abdomen is not appropriate given the additional risks posed by having vulnerable bowel structures in close proximity to the granulating bed. A correlation has been reported between the number of re-explorations after initiation of NPWT and fistula formation [70]. This reinforces the need for extreme caution during dressing changes and the use of the interface layer to minimize the impact of dressing changes.…”

Negative pressure wound therapy management of the “open abdomen” following trauma: a prospective study and systematic review

“…This leads to highly variable reported outcomes and complication rates. The rate of fascial closure in open abdomen patients treated with NPWT has been reported as low as 22% [5] (in pancreatitis) and as high as 92% [6] (in trauma). In order to understand how outcomes and potentially treatment protocols vary in different types of open abdomen patients, researchers must first publish results from homogenous and well-defined subgroups.…”

Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

“…Nowadays, abdominal NPT is indicated in patients with severe abdominal infection in cases when the source of sepsis cannot be fully controlled, in cases of ACS or in patients with acute mesenteric ischemia that can be considered for a second look [10,24-26]. Patients in whom damage control laparotomy is indicated should be considered for the application of NPT to avoid the development of ACS, visceral hypoperfusion and multiple organ failure [9,10,24,26-29].…”

“…Patients in whom damage control laparotomy is indicated should be considered for the application of NPT to avoid the development of ACS, visceral hypoperfusion and multiple organ failure [9,10,24,26-29]. Unfortunately, until now, randomised trials demonstrating the superiority of any particular TAC technique are lacking [5,30].…”

“…A study by Kaplan et al [5] clearly shows that, if the abdomen is not primarily closed within 7 to 10 days, adhesion formation and fascia retraction can render this impossible. If the application time is too long and the NPT system changes are too frequent, the rate of entero-cutaneous fistula formation, bowel obstruction, bleeding and other complications can increase [26,27,32-34]. Mortality rates vary between 7% and 38% [4,35] and can even reach 50% in patients with peritonitis, severe sepsis or septic shock [10,25].…”