Management of the open abdomen with the Abdominal Reapproximation Anchor dynamic fascial closure system

Abstract

BackgroundWith the increased use of damage control surgery and open abdomens, there are growing challenges in achieving primary fascial closure. The purpose of this study was to retrospectively review our experience using the Abdominal Reapproximation Anchor (ABRA; Canica Design Inc, Almonte, Ontario, Canada), a dynamic fascial closure system, to gain fascial apposition in complex abdominal surgical patients. MethodsA retrospective review of patients who underwent placement of the ABRA device to aid in abdominal closure was undertaken. Details including age, sex, the reason for an open abdomen, the number of operations, the time to primary closure, the success rate of primary closure, and complications related to the use of the ABRA were analyzed. ResultsBetween January 2006 and July 2011, 36 patient charts were identified. The average Acute Physiology and Chronic Health Evaluation II score was 21.9 ± 6.9. There was a mean of 3.1 ± 1.8 laparotomies before ABRA placement for each patient, and the duration of ABRA placement until removal was 10.4 ± 6.1 days. Complete fascial apposition was achieved in 83% of the patients across the entire study and in 91% of the patients in the final 2 years. Component separation was used in 17% of cases. The incisional hernia rate was 13% at 6 months and 11% at 12 months. ConclusionsOur use of the ABRA system resulted in an 83% fascial apposition rate, which further improved when experience was taken into account. The incisional hernia rate was acceptable in this complicated patient group. This technique is an excellent addition to a surgeon’s armamentarium for complicated abdominal cases that require an open abdomen. Further prospective studies are planned to identify ideal candidates for this technique.