Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

Augustin Prochotsky,Christian Bartko,Gerhard Loncsar,Jan Skultety,Jaroslav Sekac,Juraj Kutarna,Martin Hutan

doi:10.18487/npwtj.v3i2.19

Abstract

Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI). Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure.Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant. Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

Highlights

O PEN abdomen (OA) technique in the sense of „temporary abdominal closure“ (TAC) evolved in last 15 years, and found its use in a wide scale of indications encompassing complex abdominal wounds in terms of „damage control surgery“, patients with tertiary peritonitis, abdominal sepsis, and in patients with partial loss of abdominal wall.[1]
We proved statistically significant decrease of mortality by 27.64% in patient with OA, managed by negative pressure wound therapy (NPWT) vs. conventional TAC (64.71% vs. 37.04%, p = 0.0256)[7] and proved statistically significantly higher success of local management of enteroatmospheric fistula (EAF), if NPWT was used
We found out in our patients, that centripetal power of closure of wound with NPWT is not sufficient enough to counter retraction of the fascia and ensure closure of the fascia in other circumstance, than by surgical deliberation

Summary

Introduction

O PEN abdomen (OA) technique in the sense of „temporary abdominal closure“ (TAC) evolved in last 15 years, and found its use in a wide scale of indications encompassing complex abdominal wounds in terms of „damage control surgery“, patients with tertiary peritonitis, abdominal sepsis, and in patients with partial loss of abdominal wall.[1] Some of the most frequently used conventional techniques of TAC are „Bogota bag“, Witmann patch, Ethizip. In Slovakia, the most commonly used conventional technique for management of OA is „Kern laparostomy“, when OA is covered with moist. This work did not receive any financial support. Author affiliations: Surgical department, Landesklinikum Hainburg/Donau, Austria , (MH, JK, GL); 2nd surgical clinic of the Medical faculty, Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Bratislava, Slovakia, (CB, AP, JS, JŠ)

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