Abstract
Introduction: Several different temporary abdominal closure techniques are described in the context of open abdomen treatment. Techniques based on dynamic fascial closure combined with negative pressure therapy have gained popularity and seem to result in the highest fascial closure rates without increased complications and are highlighted in recent guidelines and recommendations. One dynamic closure technique is the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique, first described in 2007. The aim of this systematic review was to evaluate the VAWCM technique regarding a number of short- and long-term results.Materials and Methods: A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library databases for articles published between January 1, 2006 and May 8, 2020. The review was independently performed by the two authors according to the PRISMA statements for reporting systematic reviews and meta-analyses. Results were pooled for presentation of weighted means when applicable.Results: A total of 220 articles were screened by title and abstract. Thirty-two articles were assessed for eligibility by full-text review and 15 articles finally remained for review. A total of 600 patients treated with VAWCM were included. The pooled weighted means were as follows: fascial closure, 83.5%; enteroatmospheric fistula, 5.6%; planned ventral hernia, 6.2%; in-hospital survival, 72%; and incisional hernia incidence, 40.5%. Long-term survival ranged between 22 and 72%. Quality of life (SF-36) was reported in two studies showing lower scores than the population mean especially in physical domains. Incisional hernia resulted in lower scores in one but not in the other study.Discussion: The results of 600 VAWCM-treated patients from 15 studies were evaluated in this systematic review. Earlier findings with high fascial closure rates, low enteroatmospheric fistula, and planned ventral hernia rates as well as high incisional hernia incidences were underlined. Permanent mesh for efficient fascial traction and reinforcement at fascial closure seem to be the next step in evolving an optimal temporary closure technique in open abdomen treatment.
Highlights
Several different temporary abdominal closure techniques are described in the context of open abdomen treatment
Due to the critical conditions in these patients, it is important that the utilized temporary abdominal closure (TAC) technique minimizes the risk of complications related to the open abdomen (OA), since prolonged periods of treatment are associated with increased morbidity and mortality
Electronic database searches from January 1, 2006 to May 8, 2020 were conducted in MEDLINE (PubMed), EMBASE, and Cochrane Library Online with the purpose to identify all publications in English on OA treatment with the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique
Summary
Several different temporary abdominal closure techniques are described in the context of open abdomen treatment. Techniques based on dynamic fascial closure combined with negative pressure therapy have gained popularity and seem to result in the highest fascial closure rates without increased complications and are highlighted in recent guidelines and recommendations. One dynamic closure technique is the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique, first described in 2007. Older static TAC techniques, e.g., Bogota bag or placement of a temporary mesh, did not facilitate closure and frequently resulted in large planned ventral hernias and concomitant morbidity. The novel vacuum-assisted wound closure and mesh-mediated facial traction (VAWCM) technique, combining negative pressure wound therapy and fascial traction, was described from our department in 2007 (2). Long-term follow up showed a 54% incisional hernia (IH) incident in patients surviving 5 years, with a need for surgical repair in one third (3)
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