Open Abdomen after Two Trauma Laparotomies: Do Diuretics Help?

Data are lacking regarding the use of diuretics in facilitating closure of the open abdomen (OA). For patients with an OA after 2 laparotomies, we hypothesized that diuretic use was associated with a higher rate of primary fascial closure than no diuretic use. A retrospective review of patients with trauma laparotomies over 7 years was performed. Primary fascial closure (PFC) was defined as apposition of fascial edges without interposition mesh. Of 321 patients, 30 (9%) remained with an OA after 2 laparotomies. Prior to the third laparotomy, median cumulative fluid balance was +12.6 L. Thirteen (43%) received diuretics. Primary fascial closure rates were similar for diuretic use vs no diuretic (38% vs 59%, P = .46). Primary fascial closure was not associated with age ( P = .2), gender ( P = 0.7), cumulative fluid balance ( P = .3), or units of packed cells ( P = .4). Diuretic use in trauma patients with an OA after 2 laparotomies was not associated with successful PFC.

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Factors Associated with Inability to Perform Delayed Primary Fascial Closure of Open Abdomen in Trauma Patients: a Retrospective Observational Study

Indian Journal of Surgery ◽

10.1007/s12262-021-03184-4 ◽

2022 ◽

Author(s):

Harshit Agarwal ◽

Dinesh Bagaria ◽

Sushma Sagar ◽

Subodh Kumar ◽

Biplab Mishra ◽

...

Keyword(s):

Observational Study ◽

Open Abdomen ◽

Retrospective Observational Study ◽

Fascial Closure ◽

Trauma Patients ◽

Factors Associated ◽

Primary Fascial Closure

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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial

Military Medical Research ◽

10.1186/s40779-021-00329-0 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Kai Wang ◽

Shi-Long Sun ◽

Xin-Yu Wang ◽

Cheng-Nan Chu ◽

Ze-Hua Duan ◽

...

Keyword(s):

Fluid Resuscitation ◽

Fluid Balance ◽

Bioelectrical Impedance Analysis ◽

Open Abdomen ◽

Fluid Management ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Fascial Closure ◽

Rank Test ◽

Primary Fascial Closure

Abstract Background Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore, we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients. Methods A pragmatic, prospective, randomized, observer-blind, single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 days of ICU management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC, postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 days after OA. The Kaplan–Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built. Results A total of 134 patients completed the trial (BIA, n = 66; TRD, n = 68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33% vs. 55.88%, P < 0.001). In the BIA group, the time to PFC occurred earlier than that of the TRD group by an average of 3.66 days (P < 0.001). Additionally, the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (P < 0.001) and fewer complications. Conclusion Among postinjury OA patients in the ICU, the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.

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Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen

Hernia ◽

10.1007/s10029-012-0995-1 ◽

2012 ◽

Vol 17 (1) ◽

pp. 101-107 ◽

Cited By ~ 51

Author(s):

M. D. Zielinski ◽

N. Goussous ◽

H. J. Schiller ◽

D. Jenkins

Keyword(s):

Botulinum Toxin ◽

Open Abdomen ◽

Botulinum Toxin A ◽

Fascial Closure ◽

Chemical Components ◽

Toxin A ◽

Components Separation ◽

Novel Technique ◽

Primary Fascial Closure

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Factors affecting primary fascial closure of the open abdomen in the nontrauma patient

Surgery ◽

10.1016/j.surg.2012.07.015 ◽

2012 ◽

Vol 152 (4) ◽

pp. 777-784 ◽

Cited By ~ 31

Author(s):

Naeem Goussous ◽

Brian D. Kim ◽

Donald H. Jenkins ◽

Martin D. Zielinski

Keyword(s):

Open Abdomen ◽

Fascial Closure ◽

Factors Affecting ◽

Primary Fascial Closure

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Use of vacuum-assisted closure device in a disastrous form of abdominal sepsis and stoma site infection: Systematic review and report of a case

Acta chirurgica iugoslavica ◽

10.2298/aci1202111p ◽

2012 ◽

Vol 59 (2) ◽

pp. 111-115

Author(s):

Milos Popovic ◽

Goran Barisic ◽

Velimir Markovic ◽

Jelena Petrovic ◽

Zoran Krivokapic

Keyword(s):

Systematic Review ◽

Open Abdomen ◽

Abdominal Sepsis ◽

Fascial Closure ◽

Closure Device ◽

Diffuse Peritonitis ◽

Site Infection ◽

Vacuum Assisted Closure ◽

Primary Fascial Closure

Use of Vacuum-Assisted Closure (VAC) for treatment of open abdomen has been established predominantly in cases of severe abdominal trauma, resulting with high percentage of primary fascial closure. The role of VAC technique in cases of severe diffuse peritonitis is not definitely incorrigible. However, in cases of severe complicated abdominal sepsis VAC come up as a last resort.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.590245 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alexis Theodorou ◽

Agnes Jedig ◽

Steffen Manekeller ◽

Arnulf Willms ◽

Dimitrios Pantelis ◽

...

Keyword(s):

Quality Of Life ◽

Open Abdomen ◽

Fascial Closure ◽

Secondary Reconstruction ◽

Secondary Stage ◽

Primary Fascial Closure ◽

Hernia Incidence

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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Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

Surgical Technology Online ◽

10.52198/21.sti.38.gs1386 ◽

2021 ◽

Author(s):

Vincenzo Pappalardo ◽

Stefano Rausei ◽

Vincenzo Ardita ◽

Luigi Boni ◽

Gianlorenzo Dionigi

Keyword(s):

Negative Pressure ◽

Open Abdomen ◽

Secondary Peritonitis ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Advantages And Disadvantages ◽

Abdominal Closure ◽

Primary Fascial Closure

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

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Managing the open abdomen in a district general hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021678556 ◽

2014 ◽

Vol 96 (3) ◽

pp. 194-198 ◽

Cited By ~ 7

Author(s):

J De Siqueira ◽

O Tawfiq ◽

J Garner

Keyword(s):

General Hospital ◽

Open Abdomen ◽

Hospital Setting ◽

District General Hospital ◽

Hospital Environment ◽

Fascial Closure ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Hospital Stays ◽

The Uk

Introduction The need to manage an open abdomen is becoming more common in general surgical practice and a variety of methods of temporary abdominal closure (TAC) are available. The evidence for the efficacy of the various forms of TAC as well as the subsequent definitive fascial closure (DFC) rates and complications comes mainly from large trauma series in the US, which represent a different patient population to those in the UK in whom TAC is usually required. Methods All cases of open abdomen management in our hospital over a five-year period were reviewed to ascertain the methods of TAC used, our success in achieving DFC and the applicability of managing such cases in a district hospital environment. Results Nineteen patients underwent TAC, with two deaths (10.5%) and an overall DFC rate at hospital discharge of 12/17 (70.6%). The median lengths of critical care and hospital stays were 19.5 and 38.0 days respectively. Thirteen out of seventeen survivors had at least one significant complication. Conclusions The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.

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