The Significance of Visceral Protection in Preventing Enteroatmospheric Fistulae During Open Abdomen Treatment in Patients With Secondary Peritonitis

Willms, Arnulf; Schaaf, Sebastian; Zimmermann, Nicolay; Schwab, Robert; Güsgen, Christoph; Vilz, Tim O.; Kalff, Jörg C.; Websky, Martin W. von

doi:10.1097/sla.0000000000003440

Cited by 19 publications

(20 citation statements)

References 27 publications

(100 reference statements)

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“…There have been seven systematic reviews examining methods of TAC in the OA over the last 10 years[539,542,570,[573][574][575][576][577] and three RCTs[559,578,579]. The overall strength of the reported outcomes is low due to the small number and poor quality of comparative observational studies.Management of the OA requires a multidisciplinary approach, led jointly by the surgical and intensive care teams with input from a nutritional team, physiotherapists, complex wound and stoma nurses and guided by microbiology.Patients remain intubated following the creation of an OA after index laparotomy, primarily to facilitate repeated returns to…”

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confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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“…Patients with the indication for OAT and in whom primary fascial closure is impossible during the abdominal surgery are treated with a commercially available OAT dressing kit (ABThera TM SensaTRAC TM Open Abdomen Dressing, KCI Medical/3M, Maplewood, MN, United States). To protect the viscera from serosal lesions and prevent enteroatmospheric fistulas, a visceral protective layer integrated into the abdominal vacuum foam is implanted (19). It is placed deep laterally in the paracolic spaces to prevent lateral adhesions.…”

Section: Description Of Surgical Techniquementioning

confidence: 99%

Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

et al. 2020

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Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

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“…The main procedure-inherent risks in patients undergoing OAT are (1) the development of an entero-atmospheric fistula (EAF), (2) failure of primary fascial closure (PC) resulting in a planned ventral hernia (PVH), and (3) high rates of incisional hernias after PC. Recent studies have demonstrated that a structured approach including (a) the use of a visceral protection layer, (b) mesh-mediated fascial traction, and (c) negative pressure wound treatment reduces the above-mentioned complications significantly ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…For example, The World Society of Emergency Surgery suggests early fascial closure as the key strategy for the management of open abdomen with a grade 1B recommendation ( 8 ). The recent literature also suggests that early closure should be achieved within 10 days ( 4 , 9 ). Thus, while hospital discharge with PVH after OAT becomes less frequent, the incidence of an incisional hernia after open abdomen treatment is high ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

et al. 2021

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Background: Open abdomen treatment (OAT) is widely accepted to manage severe abdominal conditions such as peritonitis and abdominal compartment syndrome but can be associated with high morbidity and mortality. The main risks in OAT are (1) entero-atmospheric fistula (EAF), (2) failure of primary fascial closure, and (3) incisional hernias. In this study, we assessed the long-term functional outcome after OAT to understand which factors impacted most on quality of life (QoL)/daily living activities and the natural course after OAT.Materials and Methods: After a retrospective analysis of 165 consecutive OAT patients over a period of 10 years (2002–2012) with over 65 clinical parameters that had been performed at our center (1), we initiated a prospective structured follow-up approach. All survivors were invited for a clinical follow-up. Forty complete datasets including clinical and social follow-up with SF-36 scores were available for full analysis.Results: The patients were dominantly male (75%) with a median age of 52 years. Primary fascial closure (PC) was achieved in 9/40 (23%), while in 77% a planned ventral hernia (PVH) approach was followed. A total of 3/4 of the PVH patients underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of these reconstructed patients developed recurrent hernias. Fifty-five percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring (Vancouver Scar Score >8). Scar pain was described by 15% of the patients as “moderate” [Visual Analog Scale (VAS) 4–6] and by 10% as “severe” (VAS > 7). While hernia presence, PC or PVH, and scarring showed no impact on QoL, male sex and especially EAF formation significantly reduced QoL.Discussion: Despite many advantages, OAT was associated with relevant mortality and morbidity, especially in the early era before the implementation of a structured concept at our center. Follow-up revealed that hernia incidence after OAT and secondary reconstruction were high and that 25% of patients qualifying for a secondary reconstruction either did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population. With regard to hernia incidence, new strategies such as prophylactic mesh implantation upon fascial closure should be discussed analogous to other major abdominal procedures.

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The Significance of Visceral Protection in Preventing Enteroatmospheric Fistulae During Open Abdomen Treatment in Patients With Secondary Peritonitis

Cited by 19 publications

References 27 publications

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

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