scholarly journals Open abdomen treatment with negative pressure wound therapy at department for abdominal surgery, UCC Maribor: Our experiences and results

2016 ◽  
Vol 63 (1) ◽  
pp. 121-123
Author(s):  
Bojan Krebs
Keyword(s):  
Abdominal Surgery ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Pressure System ◽  
Abdominal Closure ◽  
Primary Surgery ◽  
Better Than

Introduction: With the development of modern surgery we often come to situation where, after the procedure, closing of abdomen is not feasable. There are many techniques of temporary abdominal closure but best results today are achieved with negative pressure system. Despite widespread use, there is still a lot of confusion regarding the indications, the application of the technique and complications. Objective: The aim of our study was to explain the system with negative pressure and show our experience and results in the treatment of patients with it. Methods: We retrospectively analyzed the data of all patients from 2011 to 2014 which were treated with negative pressure. We were interested in following data: the date of the primary surgery, diagnosis, date and indication for use of the system with negative pressure, the number of system changes, type of final closure of the abdominal cavity and the date of discharge or death. Results: Between 2011 and 2014 we treated 52 patients, 32 men and 20 women with a system with negative pressure. The average age of the patients was 67 years (25 - 85 years). 25 patients were operated on electively and due to complications we used the system for negative pressure. In 27 patients we used negative pressure system after the primary emergency procedure. Mortality was 50 %. Conclusion: The treatment of the open abdomen with negative pressure is an essential part of modern abdominal surgery. Survival after treatment with negative pressure is better than with other techniques of temporary abdominal closure. Man must take in consideration problems with fascial closure and big postoperative hernias wich demand further operations.

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

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.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

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.

Complications and Mortality Associated with Temporary Abdominal Closure Techniques: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 83 (2) ◽  
pp. 191-216 ◽  
Author(s):  
Adam Cristaudo ◽  
Scott Jennings ◽  
Ronny Gunnarsson ◽  
Alan Decosta
Keyword(s):  
Systematic Review ◽  
Open Abdomen ◽  
Meta Analysis ◽  
Final Analysis ◽  
Fascial Closure ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Central Register

Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov. All studies describing TAC technique use in the open abdomen were eligible for inclusion. Data were analyzed per TAC technique in the form of a meta-analysis. A total of 225 articles were included in the final analysis. A meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure [mean difference (MD): 35% ± 23%; P = 0.0044]. A subsequent meta-analysis involving all included studies confirmed its superiority across outcomes for definitive fascial closure (MD: 19% ± 3%; P < 0.0001), perioperative (MD: -4.0% ± 2.4%; P = 0.0013) and in-hospital (MD: -5.0% ± 2.9%; P = 0.0013) mortality, entero-atmospheric fistula (MD: 22.0% ± 1.8%; P = 0.0041), ventral hernia (MD: -4.0% ± 2.4%; P = 0.0010), and intra-abdominal abscess (MD: -3.1% ± 2.1%; P = 0.0044). Therefore, it was concluded that NPWT with continuous fascial traction is superior to NPWT alone.

Challenges in the Management of the Open Abdomen

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 33-39 ◽  
Author(s):  
David J. Worhunsky ◽  
Gregory Magee ◽  
David A. Spain
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Original Description ◽  
Fascial Closure ◽  
Critically Ill Patient ◽  
Temporary Abdominal Closure ◽  
Recurrence Rates ◽  
Abdominal Closure ◽  
Intra Abdominal Infection ◽  
Temporary Closure

First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogotá bag to vacuum-assisted techniques; a combined technique of sequential fascial closure with vacuum assistance has recently been shown to result in 100% fascial approximation. In situations where fascial closure is unattainable, temporary coverage with a skin graft may be employed, followed by late abdominal closure via complex abdominal herniorrhaphy. Even using advanced methods such as component separation or a “pork sandwich” technique, the complication and recurrence rates remain high. A careful understanding of the indications, optimal management, and potential complications of the open abdomen is necessary to limit its overuse and ultimately reduce some of the challenges associated with it.

Open Abdomen Treatment for Septic Patients with Gastrointestinal Fistula: From Fistula Control to Definitive Closure

2014 ◽  
Vol 80 (4) ◽  
pp. 339-347 ◽  
Author(s):  
Jianan Ren ◽  
Yujie Yuan ◽  
Yunzhao Zhao ◽  
Guosheng Gu ◽  
Gefei Wang ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Fascial Closure ◽  
Wound Complications ◽  
Temporary Abdominal Closure ◽  
Gastrointestinal Fistula ◽  
Operative Strategy ◽  
Abdominal Infection ◽  
Abdominal Closure ◽  
Intra Abdominal Infection

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

scholarly journals Immediate Closure of Abdominal Cavity with Biologic Mesh versus Temporary Abdominal Closure of Open Abdomen in Non-Trauma Emergency Patients (CLOSE-UP Study)

2020 ◽  
Vol 21 (8) ◽  
pp. 694-703 ◽  
Author(s):  
Fleur E.E. de Vries ◽  
Jeroen J.M. Claessen ◽  
Jasper J. Atema ◽  
Oddeke van Ruler ◽  
Marja A. Boermeester ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Abdominal Cavity ◽  
Biologic Mesh ◽  
Temporary Abdominal Closure ◽  
Emergency Patients ◽  
Abdominal Closure

scholarly journals Overview on Temporary Abdominal Closure Techniques: A Review

2021 ◽  
pp. 68-74
Author(s):  
Hashem Bark Awadh Abood ◽  
Sadeel Fahad Daghistani ◽  
Nouf Hashem Koshak ◽  
Yazid Ali Alghamdi ◽  
Sahad sami Ghamri ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Abdominal Hypertension ◽  
Fluid Regulation ◽  
Abdominal Compartment ◽  
Emergency Abdominal Surgery ◽  
The Ideal

Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.

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