Does the routine skin only closure in ruptured Abdominal Aortic Aneurysm repair safely diminish abdominal compartment syndrome? A hypothesis generating retrospective study.

Abstract

Abdominal compartment syndrome (ACS) often complicates ruptured abdominal aortic aneurysm (rAAA) repair. We aim to report results with routine skin-only abdominal wound closure after rAAA surgical repair. Single center, retrospective study including consecutive patients undergoing rAAA surgical repair during 7-years. Skin-only closure was routinely performed and if possible, secondary abdominal closure was performed during the same admission. Demographic information, preoperative hemodynamic condition of patients, perioperative information such as ACS, mortality and rate of abdominal closure and postoperative information were collected. During the study period 93 rAAAs were recorded. Ten patients were too frail to undergo repair or refused treatment. Eighty-three patients underwent immediate surgical repair. Mean age was 72.4±10.5 years and the vast majority were male (82:1). Preoperative systolic blood pressure <90mmHg was recorded in 31 patients. Intra-operative mortality was recorded in 9 cases. Overall in-hospital mortality was 34.9% (29/83). Primary fascial closure was performed in 5 patients, while skin-only closure was performed in 69. ACS was recorded in two cases in whom skin sutures were removed and negative pressure wound treatment was applied. Secondary fascial closure was feasible in 30 patients during the same admission. Among 37 patients not undergoing fascial closure, 18 died and 19 survived and were discharged with a planned ventral hernia. Median length of ICU and hospital stay were 5(1-24) and 13(8-35) days, respectively. After a mean follow-up of 21 months, telephone contact was possible with 14/19 patients that left the hospital with an abdominal hernia. Three reported hernia-related complications mandating surgical repair, while in 11 this was well tolerated. Routine skin-only closure during rAAA surgical repair results in low rates of ACS at the expense of a high rate of patients being discharged with a planned ventral hernia which, however, seems to be well tolerated by the majority of patients.