9. OPEN ABDOMEN: ANALYSIS OF RESULTS AFTER 7 YEARS SINCE ITS PROTOCOLIZATION IN A THIRD-LEVEL HOSPITAL

Abstract

Abstract Introduction The open abdomen (OA) procedure is a useful resource in critical situations. Its use has increased significantly since the development of negative pressure therapy (NPT) and the implementation of specific protocols. Methods Retrospective descriptive study in a third level hospital between January 2015 and December 2022. All patients who required OA were included. Results 92 patients (68 men, 24 women) underwent surgery, with a mean age of 65 years, 65.3% were ASA 3-4. Although there were multiple indications for open abdomen, more than 50% were due to intestinal ischemia or damage control surgery. 45 patients were closed without need of replacement, while in the remaining cases, the first replacement was conducted within 48-72 hours, requiring a mean of 3.5 changes. 14 patients died before the definitive closure. Of the 78 patients who were closed, 24 patients died before discharge, there were 54 survivors. The median follow-up time was 22 months. Among the 30 patients with primary fascial closure, 5 developed incisional hernias. In contrast, among the 43 patients treated with prophylactic mesh, there were no instances of eventrations, although one case of chronic rejection and one of enterocutaneous fistula were reported. 9 patients died during follow-up. Conclusion Although OA is a useful resource, it must not be forgotten that it is used in complex patients with high morbidity and mortality in the short and long term. These patients have multiple risk factors for the development of incisional hernias, justifying the use of prophylactic mesh.