Laparostomy and temporary abdominal closure outcomes in emergency non-trauma surgery and parameters affecting early definite 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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Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

Gastroenterology Research and Practice ◽

10.1155/2016/2073260 ◽

2016 ◽

Vol 2016 ◽

pp. 1-15 ◽

Cited By ~ 12

Author(s):

Qian Huang ◽

Jieshou Li ◽

Wan-yee Lau

Keyword(s):

Damage Control ◽

Synthetic Mesh ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Fascial Defect ◽

Components Separation ◽

Abdominal Closure ◽

Combined Use ◽

Early Primary ◽

Primary Fascial Closure

Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.

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Open abdomen management: single institution experience

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002005 ◽

2015 ◽

Vol 42 (2) ◽

pp. 93-96 ◽

Cited By ~ 1

Author(s):

Adilson Costa Rodrigues Junior ◽

Fernando da Costa Ferreira Novo ◽

Rafael de Castro Santana Arouca ◽

Francisco de Salles Collet e Silva ◽

Edna Frasson de Souza Montero ◽

...

Keyword(s):

Abdominal Wall ◽

Statistical Significance ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Inclusion Criteria ◽

Single Institution ◽

Abdominal Closure ◽

The Difference ◽

Mean Time ◽

De Medicina

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure

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Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x155446 ◽

2007 ◽

Vol 89 (1) ◽

pp. 57-61 ◽

Cited By ~ 15

Author(s):

JM Wilde ◽

MA Loudon

Keyword(s):

Critically Ill ◽

Damage Control ◽

Injured Patient ◽

Damage Control Surgery ◽

Traumatic Experience ◽

Fascial Closure ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Operative Severity Score

INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients. PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission. CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality.

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

Acta chirurgica iugoslavica ◽

10.2298/aci1601121k ◽

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.

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

The American Surgeon ◽

10.1177/000313481708300220 ◽

2017 ◽

Vol 83 (2) ◽

pp. 191-216 ◽

Cited By ~ 13

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.

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Challenges in the Management of the Open Abdomen

ICU Director ◽

10.1177/1944451612469628 ◽

2012 ◽

Vol 4 (1) ◽

pp. 33-39 ◽

Cited By ~ 1

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.

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OUTCOME OF SKIN ONLY TEMPORARY ABDOMINAL CLOSURE METHOD AND REPEATED PERITONEAL WASH IN PATIENTS WITH SECONDARY PERITONITIS

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2013.3.2.323-327 ◽

1969 ◽

Vol 3 (2) ◽

pp. 323-327

Author(s):

LIAQAT ALI SHAH ◽

MUNIR AHMAD ◽

ASHFAQ UR REHMAN ◽

TARIQ SOHAIL ◽

NADIM KHAN ◽

...

Keyword(s):

Hospital Stay ◽

Secondary Peritonitis ◽

Fascial Closure ◽

Categorical Variables ◽

Skin Closure ◽

Temporary Abdominal Closure ◽

Female Ratio ◽

Surgical Department ◽

Abdominal Closure ◽

Closure Method

OBJECTIVE: To determine the outcome of skin only temporary abdominal wall closure and repeatedperitoneal wash therapy in the management of secondary peritonitis in terms of fascial closure and mortality.MATERIAL AND METHODS: This prospective descriptive study was conducted on 80 patients withsecondary peritonitis, selected by convenience non probability sampling technique after fulfilling theinclusion and exclusion criteria, in emergency surgical department of Govt PGMI Lady Reading HospitalPeshawar from January 2011 to July 2012. Patients were diagnosed on the basis of history, clinicalexamination, heamatological and radiological investigations , operated in casualty and skin onlytemporary abdominal closure method was applied with prolene 2/0 and planned re-laparotomy was carriedout after 24 hours. Further re-laparotomies were decided by the operating surgeon till proper fascial closure.The impact of skin only closure and number of operations were analyzed postoperatively in terms of fascialclosure and mortality. The demographic and clinical ( intraoperative and postoperative ) data of the allpatients such as name, age, gender, duration of hospital stay, indication and number of operations wererecorded in a proforma.The data was analyzed with SPSS version 16. Frequency and percentages werecomputed for categorical variables such as gender and number of operations, fascial closure and mortalitywhile numerical variables such as age, hospital stay was presented with Mean ± SD.RESULTS: A total of 80 patients were included in the study and out of which 55 (68.8%) were male and 25(31.2% ) female with male to female ratio of 2.2:1 . The age of patients ranged from 18 to 65 years. The meanage was 37.83 ±1.194. The ranged of re-operations were 1 to 4 with mean 2.06± 0.785. The ranged ofhospital stay was 9- 50 days with mean 21± 7.719.The fascial closure was 82.5% and mortality was 13.8%.CONCLUSION: Peritoneal wash is life saving procedure in the treatment of secondary peritonitis and skinonly temporary abdominal closure is easy, quick and fascial preserving procedure. Both techniques shouldbe encouraged in secondary peritonitiscases.KEYWORDS:Peritonitis, Re-Laparatomy,Skin Closure.

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

The American Surgeon ◽

10.1177/000313481408000414 ◽

2014 ◽

Vol 80 (4) ◽

pp. 339-347 ◽

Cited By ~ 12

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.

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Overview on Temporary Abdominal Closure Techniques: A Review

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i57a33970 ◽

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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