Outcome of Negative-pressure Wound Therapy for Open Abdomen Treatment After Nontraumatic Lower Gastrointestinal Surgery: Analysis of Factors Affecting Delayed Fascial Closure in 101 Patients

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2013 Dec 17

PMID 24337240

Citations 12

Authors

Claus Anders Bertelsen

Rasmus Fabricius

Jakob Kleif

Bent Kristensen

Ismail Gogenur

Affiliations

Soon will be listed here.

Abstract

Background: Few studies have focused on the risk factors for failure to achieve fascial closure after use of negative-pressure wound therapy (NPWT) in an open abdomen (OA). We aimed at analyzing possible risk factors for failure of fascial closure and the risk of fistulas after nontrauma lower gastrointestinal (GI) tract surgery treated with OA.

Methods: This retrospective study included 101 nontrauma patients treated with OA from 2007 to 2011. Multivariate analyses of risk factors were performed.

Results: Indications for OA were diffuse peritonitis (n = 47), need for second look (n = 26), failure to achieve fascial closure (e.g., bowel edema) at primary laparotomy (n = 24), and fascial necrosis (n = 4). Of the 101 patients, 61 (60 %) were alive at discharge, with one death possibly related to OA (fistula from an iatrogenic perforation). Delayed fascial closure was obtained in 40 (66 %) of the surviving patients, with 80 % when the indications for OA was need for second look and 72 % in cases of diffuse peritonitis. Compared with need for second look [hazard ratio (HR = 1), 95 % CI], proportional HR for failure of delayed fascial closure were peritonitis 1.96 (1.10-3.49) and failure to achieve fascial closure at primary laparotomy 4.70 (2.17-10.2). In the presence of a stoma the HR was 2.02 (1.13-3.63).

Conclusions: OA using NPWT seems to be a safe procedure, with few procedure-related complications. Failure of fascial closure is related to the indication of OA and the presence of a stoma. Prospective multicenter studies are needed to establish which patients with lower GI surgery benefit from OA.

Citing Articles

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Negative-Pressure Wound Therapy: What We Know and What We Need to Know.

Yamashiro T, Kushibiki T, Mayumi Y, Tsuchiya M, Ishihara M, Azuma R Adv Exp Med Biol. 2023; 1436:131-152.

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Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis-the VACOR trial: protocol for a randomised controlled trial.

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Willms A, Schwab R, von Websky M, Berrevoet F, Tartaglia D, Sorelius K Hernia. 2020; 26(1):61-73.

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Prophylactic negative wound therapy in laparotomy wounds (PROPEL trial): randomized controlled trial.

Donlon N, Boland P, Kelly M, Schmidt K, Cooke F, Neary P Int J Colorectal Dis. 2019; 34(11):2003-2010.

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References

Waibel B, Rotondo M . Damage control in trauma and abdominal sepsis. Crit Care Med. 2010; 38(9 Suppl):S421-30. DOI: 10.1097/CCM.0b013e3181ec5cbe. View

Smart N, Marshall M, Daniels I . Biological meshes: a review of their use in abdominal wall hernia repairs. Surgeon. 2012; 10(3):159-71. DOI: 10.1016/j.surge.2012.02.006. View

Hlebowicz J, Hansson J, Lindstedt S . Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen. Int J Colorectal Dis. 2011; 27(3):397-403. PMC: 3281201. DOI: 10.1007/s00384-011-1317-2. View

Roberts D, Zygun D, Grendar J, Ball C, Robertson H, Ouellet J . Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review. J Trauma Acute Care Surg. 2012; 73(3):629-39. DOI: 10.1097/TA.0b013e31825c130e. View

Carlson G, Patrick H, Amin A, McPherson G, MacLennan G, Afolabi E . Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg. 2013; 257(6):1154-9. DOI: 10.1097/SLA.0b013e31828b8bc8. View

Mentula P . Non-traumatic causes and the management of the open abdomen. Minerva Chir. 2011; 66(2):153-63. View

Goussous N, Kim B, Jenkins D, Zielinski M . Factors affecting primary fascial closure of the open abdomen in the nontrauma patient. Surgery. 2012; 152(4):777-83. DOI: 10.1016/j.surg.2012.07.015. View

Rao M, Burke D, Finan P, Sagar P . The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis. 2007; 9(3):266-8. DOI: 10.1111/j.1463-1318.2006.01154.x. View

van Hensbroek P, Wind J, Dijkgraaf M, Busch O, Goslings J . Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2008; 33(2):199-207. PMC: 3259401. DOI: 10.1007/s00268-008-9867-3. View

10.

Amin A, Shaikh I . Topical negative pressure in managing severe peritonitis: a positive contribution?. World J Gastroenterol. 2009; 15(27):3394-7. PMC: 2712900. DOI: 10.3748/wjg.15.3394. View

11.

Caro A, Olona C, Jimenez A, Vadillo J, Feliu F, Vicente V . Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases. Int Wound J. 2011; 8(3):274-9. PMC: 7950746. DOI: 10.1111/j.1742-481X.2011.00782.x. View

12.

Quyn A, Johnston C, Hall D, Chambers A, Arapova N, Ogston S . The open abdomen and temporary abdominal closure systems--historical evolution and systematic review. Colorectal Dis. 2012; 14(8):e429-38. DOI: 10.1111/j.1463-1318.2012.03045.x. View

13.

Fieger A, Schwatlo F, Mundel D, Schenk M, Hemminger F, Kirchdorfer B . [Abdominal vacuum therapy for the open abdomen - a retrospective analysis of 82 consecutive patients]. Zentralbl Chir. 2011; 136(1):56-60. DOI: 10.1055/s-0030-1247376. View

14.

Shaikh I, Ballard-Wilson A, Yalamarthi S, Amin A . Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae. Colorectal Dis. 2009; 12(9):931-4. DOI: 10.1111/j.1463-1318.2009.01929.x. View

15.

Adkins A, Robbins J, Villalba M, Bendick P, Shanley C . Open abdomen management of intra-abdominal sepsis. Am Surg. 2004; 70(2):137-40. View

16.

Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien P . Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg. 2007; 205(4):586-92. DOI: 10.1016/j.jamcollsurg.2007.05.015. View

17.

Robledo F, Luque-de-Leon E, Suarez R, Sanchez P, de-la-Fuente M, Vargas A . Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect (Larchmt). 2007; 8(1):63-72. DOI: 10.1089/sur.2006.8.016. View

18.

Hoyrup S, Bruun J, Bertelsen C . Use of biological mesh in facilitation of early closure in potentially infected abdominal wall defects. Dan Med J. 2012; 59(3):A4389. View

19.

Kafka-Ritsch R, Zitt M, Schorn N, Stroemmer S, Schneeberger S, Pratschke J . Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate. World J Surg. 2012; 36(8):1765-71. DOI: 10.1007/s00268-012-1586-0. View

20.

Acosta S, Bjarnason T, Petersson U, Palsson B, Wanhainen A, Svensson M . Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg. 2011; 98(5):735-43. DOI: 10.1002/bjs.7383. View