Abstract
BackgroundNo definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA).MethodsA prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org.ResultsFour hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016).Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days.ConclusionTemporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results.Trial registrationClinicalTrials.gov NCT02382770
Highlights
No definitive data about open abdomen (OA) epidemiology and outcomes exist
The different techniques account for different results according to the different indications
Temporary abdominal closure technique (TACT) or open abdomen (OA) techniques were firstly described more than 120 years ago [1]
Summary
The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). OA procedure is defined as intentionally leaving the fascial edges of the abdomen un-approximated (laparostomy). Patients treated with OA procedures are absolutely heterogeneous even within the same study and large cohorts of patients treated with the same procedures are rare [2,3,4,5,6,7] To overcome this lack of high level of evidence data about the OA indications, management, definitive closure, and follow-up, the World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA) [2]
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