Open abdomen and temporary abdominal closure techniques with negative pressure

Abstract

Introduction Nowadays, the open abdomen is widely accepted method for а treatment of severe trauma, severe diffuse peritonitis and abdominal compartment syndrome. During the past 30 years numerous techniques for temporary abdominal closure have been described. The aim of the present study is to review the literature and to compare the effectiveness of the techniques with negative pressure – vacuum pack (VP) and Vacuum Assisted Closure (V.A.C., KCI), which have received a vast popularity in the last two decades. Material and methods The literature search was performed in PUBMED for the period 1995-2014 with key words – “open abdomen”, “temporary abdominal closure”, “VP”, “V.A.C.”. For the purpose of the review, only original articles with a clear description of the methodology and results were considered. Results For the period 2002-2014, 17 eligible studies evaluating the outcome in V.A.C. only and were found with overall 1146 patients and 8 studies reporting V.A.C. with dynamic fascial closure with 413 patients. For the same period, 12 studies evaluating effectiveness of VP only with 921 patients and 4 VP with dynamic fascial closure with 218 patients were found. There were only 2 studies directly comparing VP and V.A.C. Conclusions The literature review demonstrates higher rate of primary fascial closure and lower mortality rate in V.A.C. in comparison to VP on the background of similar frequency of EAFs and intraabdominal abscesses. Based on the results and on our own experience the use of dynamic fascial closure in addition to V.A.C. facilitates the primary fascial closure and should be used in all cases with expected duration of the OA over 9 days. Due to the possible complications the wanton use of the open abdomen should be avoided and all efforts for early closure should be made in the course of the treatment.