SP5.2.3 Comparison of Open Abdomen Management Techniques in a cohort of patients with Encapsulating Peritoneal Sclerosis – A large single centre retrospective review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Aidan Bannon ◽  
Robert Leatherby ◽  
Linda Birtles ◽  
Titus Augustine ◽  
Zia Moinuddin ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Single Centre ◽  
Wound Therapy ◽  
Patient Demographics ◽  
Patient Groups ◽  
Management Techniques

Abstract Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therapy (NPWT) with packing (betadine-soaked gauze) as temporary abdominal closure (TAC) techniques in OA management. Methods We performed retrospective analysis of a contemporaneously maintained database of all patients who underwent surgery for EPS between 2010-2020. A variety of variables were included with the primary endpoint being time to definitive fascial closure. Patient demographics, surgical complications, subsequent method of closure (including mesh usage) and outcomes were recorded. Results 99/122 patients underwent open abdomen management. 43/99 were managed with NPWT and 56/99 were managed with packing. The NPWT group had significantly higher fascial closure rates without need for subsequent bridged (mesh) closure when compared to the packed abdomen [62.8% vs 12.5%, (p < 0.001, c2 test)]. In the NPWT group, there were also fewer failed closures [4.7% vs 19.6%, (p = 0.03, c2 test)] along with shorter time to definitive closure and reduced theatre episodes. No incidence of intestinal fistulation was associated with NPWT. Conclusion This study provides definitive guidance as to the benefit of ABTHERATM open abdomen NPWT for fascial closure following open abdominal management. ABTHERATM open abdomen NPWT provides significant advantages over traditional methods of TAC and may provide benefit in OA management in other patient groups (sepsis and trauma) as well.

scholarly journals Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Martin Hutan ◽  
Christian Bartko ◽  
Augustin Prochotsky ◽  
Jaroslav Sekac ◽  
Jan Skultety ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
High Morbidity ◽  
Temporary Abdominal Closure ◽  
Wound Therapy ◽  
Mortality And Morbidity ◽  
Prospective Assessment ◽  
Sequential Closure

Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI). Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure.Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant. Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

scholarly journals Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

2020 ◽  
Vol 44 (12) ◽  
pp. 4032-4040
Author(s):  
Federico Coccolini ◽  
◽  
Francesca Gubbiotti ◽  
Marco Ceresoli ◽  
Dario Tartaglia ◽  
...  
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Wound Therapy ◽  
Closure Rate ◽  
Severe Peritonitis ◽  
Fistula Rate ◽  
Baseline Characteristics ◽  
Overall Mortality

Abstract Background Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.

scholarly journals Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kouki Imaoka ◽  
Takuya Yano ◽  
Yasuhiro Choda ◽  
Ko Oshita ◽  
Yuma Tani ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Anterolateral Thigh Flap ◽  
Temporary Abdominal Closure ◽  
Ascending Colon ◽  
Wound Therapy ◽  
Pressure Therapy ◽  
New Device

Background. The practice of leaving the abdomen open after an emergency laparotomy has gained increasing popularity recently. Negative pressure wound therapy (NPWT) is known as an effective technique in the management of an open abdomen (OA). A new device, the ABThera™ Open Abdomen Negative Pressure Therapy System (KCI USA, San Antonio, TX, USA), was specifically designed to achieve a temporary abdominal closure (TAC) in the management of an OA. This study was aimed at presenting a successful experience of treating a case of abdominal wall necrosis caused by a perforated ascending colon using the ABThera System. Case Presentation. A 66-year-old man was admitted to our hospital with complaints of severe pain in the abdomen. On admission, abdominal contrast-enhanced computed tomography (CT) showed fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the adipose tissue in the peritoneum and abdominal wall. Based on a diagnosis of peritonitis resulting from a perforated ascending colon, emergency surgery was performed. A right hemicolectomy, ileostomy construction, and debridement of the necrotic tissues were performed. However, necrotizing fasciitis rapidly spread; therefore, more necrotic tissue was debrided in a second operation. The abdominal wall defect was left open, and the ABThera System was used in the management of the OA; this device promoted wound healing. A reduction was observed in the size of the open wound with visible granulation tissue. The defect was finally covered with a mesh split-thickness skin graft and anterolateral thigh flap. Conclusions. In the management of a case of a massive wound with infection, it can be of great benefit to treat the wound with NPWT initially to decrease its size. The ABThera System could facilitate early and safe management of an OA by surgeons.

scholarly journals Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

2016 ◽  
Vol 106 (2) ◽  
pp. 145-151 ◽  
Author(s):  
M. Kääriäinen ◽  
M. Kuuskeri ◽  
M. Helminen ◽  
H. Kuokkanen
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Component Separation ◽  
Separation Technique ◽  
Fascial Closure ◽  
Study Patient ◽  
Wound Therapy ◽  
Closure Rate ◽  
Component Separation Technique

Background and Aims: The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Material and Methods: Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Results and Conclusion: Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.

scholarly journals Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Sven Richter ◽  
Stefan Dold ◽  
Johannes P. Doberauer ◽  
Peter Mai ◽  
Jochen Schuld
Keyword(s):  
Risk Factors ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fistula Formation ◽  
Temporary Abdominal Closure ◽  
Wound Therapy ◽  
Predisposing Factor ◽  
Intestinal Fistulas ◽  
The Impact

Introduction.The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas.Methods.The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients’ demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded.Results.Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during () or after NPWT (). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas.Conclusion.The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.

scholarly journals Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry

Hernia ◽  
2020 ◽  
Author(s):  
A. G. Willms ◽  
◽  
R. Schwab ◽  
M. W. von Websky ◽  
F. Berrevoet ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Negative Pressure ◽  
Odds Ratio ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Multivariable Analysis ◽  
Fascial Closure ◽  
Wound Therapy ◽  
Closure Rate ◽  
European Hernia Society

Abstract Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.

scholarly journals EP.FRI.337 Active management of the open abdomen in non-trauma catastrophes, including use of negative pressure wound therapy, is associated with high primary fascial closure rates

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dheepa Nair ◽  
Jessica Banks ◽  
Richard Guy
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Enterocutaneous Fistula ◽  
Damage Control Surgery ◽  
Active Management ◽  
Fascial Closure ◽  
Emergency Laparotomy ◽  
Wound Therapy ◽  
Primary Fascial Closure

Abstract Aims Deliberate use of the open abdomen (OA) following emergency laparotomy (EL) may be life-saving in the non-trauma abdominal catastrophe (NTAC) and damage control surgery (DCS) can reduce the risk of abdominal compartment syndrome in compromised patients. Controversy exists over optimum management of the abdominal wall. An audit was undertaken of negative pressure wound therapy (NPWT) in OA patients. Methods All patients who underwent OA management of NTAC from 1st Jan 2019 to 31st Dec 2020 were identified. Data on patient demographics, indication for OA and clinical outcomes were analysed. Results Eighteen patients (median age 65.5 years; M:F9 each) underwent OA  following EL. The indications were: bowel ischaemia (8), intra-abdominal sepsis (5), grossly distended bowel (3) and intra-abdominal haemorrhage (2). In all cases, ABTHERATM dressings (KCI/Acelity) were used. Mean ICU stay was 7.4 days (range 1-15) and mean hospital stay 33 days (range 2-61). Four patients died, 3 within 24 hours of initial EL. Relook laparotomy was performed within 48 hours in the remaining 15 patients; 3 patients required 2 relooks and 1 patient had three. Primary fascial closure (PFC) was achieved within five days in 13/14 (93%) survivors. Eight patients had SSIs with 2 intra-abdominal collections and all were treated conservatively. One patient developed an enterocutaneous fistula. Conclusions The use of commercially-available NPWT dressings in OA management is associated with high PFC rates within one week of initial EL. This practice is consistent with World Society of Emergency Surgery guidance recommending planned re-look laparotomy within 48 hours.

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