Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

Abstract

BackgroundThis study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This “open abdomen” must then be temporarily closed. However, the FC rate varies between techniques.MethodsThe Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) “open abdomen,” “fascial closure,” “vacuum,” “reapproximation,” and “ventral hernia.” Open abdomen was defined as “the inability to close the abdominal fascia after laparotomy.” Two reviewers independently extracted data from original articles by using a predefined checklist.ResultsThe search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%).ConclusionsThese results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rates.

Acute kidney injury following acute pancreatitis: A review

“…Plaudis et al described abdominal negative-pressure therapy in their prospective study with 25 surgical patients as a new method in countering ACS and peritonitis 90 . However, management of the open abdomen is still associated with a number of complications including persistent sepsis and development of multiple organ dysfunction [91][92][93] . The second step is control of fluid balance for maintenance of adequate organ perfusion and also to control the third space.…”

How to deal with an open abdomen?

“…One of the oldest described methods of preventing lateralization of the bowel wall is the Wittmann patch [39], a system of non-permeable Velcro patches that has the great advantage of being possible to approximate in the intensive care unit without having to send the patient to the operation room. Although there have been reports on patients suffering enteroatmospheric fistula with this technique, the risk was only 2% in a meta-analysis where 4 studies including 180 patients treated with this technique were included [40].…”

Challenges of Complex Open Abdominal Wound Management in Trauma: A Novel Use of Chitosan and Hyaluronic Acid as a 3-Dimensional Scaffold to Overcome Resilient Open Abdomen Infections

“…NPWT does not completely overcome the challenges posed by mesh degradation, inevitable epiboly at the peri-wound, or complex wound gutters. 3 This case demonstrates a novel approach to complex open abdomen wound management utilizing NPWT in combination with 2 unique dressings, chitosan and hyaluronic acid. Hyaluronic acid (HA), is unique among glycosaminoglycans in that it is nonsulfated, forms E-mail address: tammy_luttrell@msn.com in the plasma membrane, instead of the Golgi apparatus, and can be very large, with its molecular weight often reaching the millions.…”

“…Moreover, these patients can now be closed within the initial hospitalization. 3 These techniques and technologies include the appropriate use of negative pressure therapy (NPWT) 4 and synthetic or biologic repair materials. 5 It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open abdomen.…”