Abstract
BackgroundWe reviewed our experience with patients presenting with trauma and peritonitis who underwent an open abdomen (OA) procedure, and compared outcomes between Negative Pressure Wound Therapy (NPWT) and a modified Barker Vacuum Pack (mBVP) technique.MethodsIn this descriptive study, we retrospectively analyzed data regarding all patients who underwent OA for intra-abdominal sepsis or abdominal trauma at our Centre from January 2012 to December 2015. Demographic data, co-morbidities, indications to surgery, intra-operative details and Björck classification grade were considered. Outcomes included were: time to closure in days, fascial closure rates, ICU and hospital stay, in-hospital and overall mortality, and entero-atmospheric fistula rate.ResultsA total of 83 cases were considered. Mean closure time was 6 days versus 6.5 days (p = 0.71) in NPWT and mBVP groups, respectively; the fascial closure rate was 75.4% versus 93.8% (p = 0.10). At multivariate analysis, in-hospital and overall mortality were significantly higher within the mBVP, as compared to NPWT (OR 3.8, 95% CI 1.1 to 13.1, p = 0.02 – OR 4.2, 95% CI 1.2 to 14.1, p = 0.01). Entero-atmospheric fistula rate was 2.6% in the two groups.ConclusionsNPWT as a temporary abdominal closure technique, as compared to mBVP, appears to be associated with better outcomes in terms of mortality.
Highlights
We reviewed our experience with patients presenting with trauma and peritonitis who underwent an open abdomen (OA) procedure, and compared outcomes between Negative Pressure Wound Therapy (NPWT) and a modified Barker Vacuum Pack technique
Atema et al [4], in their analysis on non-traumatized patients, found that Negative Pressure Wound Therapy (NPWT) had the highest fascial closure rates, especially when performed with continuous mesh or suture-mediated fascial traction and dynamic retention sutures; this approach was related to a low incidence of fistula, which resulted to be equal to 5.7% for patients with fascial closure and NPWT
The patients considered in the current study were treated either with a NPWT commercial device (such as ABtheraTM Open Abdomen Negative Pressure Therapy device (Kinetic Concepts Inc., San Antonio, TX) [2] and Suprasorb® CNP P1 (Lohmann and Rauscher, Vienna, AU) [5, 6] or with a hand-made vacuum-assisted system; in particular, we used a modified BVP technique, similar to the approach described by Barker et al [7]
Summary
We reviewed our experience with patients presenting with trauma and peritonitis who underwent an open abdomen (OA) procedure, and compared outcomes between Negative Pressure Wound Therapy (NPWT) and a modified Barker Vacuum Pack (mBVP) technique. Open abdomen (OA) has become a commonly-used approach for the management of peritonitis and abdominal trauma in recent years This technique presents several advantages: it allows the surgeon to treat or prevent intra-abdominal hypertension (IAH) and to manage abdominal compartment syndrome (ACS). It dramatically decreases the operative time of traumarelated laparotomies, being in line with principles of Damage Control Surgery: bleeding and contamination control, rapidly transfer the patient to Intensive Care Unit for resuscitation. Atema et al [4], in their analysis on non-traumatized patients, found that Negative Pressure Wound Therapy (NPWT) had the highest fascial closure rates, especially when performed with continuous mesh or suture-mediated fascial traction and dynamic retention sutures; this approach was related to a low incidence of fistula, which resulted to be equal to 5.7% for patients with fascial closure and NPWT
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