SP5.2.3 Comparison of Open Abdomen Management Techniques in a cohort of patients with Encapsulating Peritoneal Sclerosis – A large single centre retrospective review

Abstract

Abstract Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therapy (NPWT) with packing (betadine-soaked gauze) as temporary abdominal closure (TAC) techniques in OA management. Methods We performed retrospective analysis of a contemporaneously maintained database of all patients who underwent surgery for EPS between 2010-2020. A variety of variables were included with the primary endpoint being time to definitive fascial closure. Patient demographics, surgical complications, subsequent method of closure (including mesh usage) and outcomes were recorded. Results 99/122 patients underwent open abdomen management. 43/99 were managed with NPWT and 56/99 were managed with packing. The NPWT group had significantly higher fascial closure rates without need for subsequent bridged (mesh) closure when compared to the packed abdomen [62.8% vs 12.5%, (p < 0.001, c2 test)]. In the NPWT group, there were also fewer failed closures [4.7% vs 19.6%, (p = 0.03, c2 test)] along with shorter time to definitive closure and reduced theatre episodes. No incidence of intestinal fistulation was associated with NPWT. Conclusion This study provides definitive guidance as to the benefit of ABTHERATM open abdomen NPWT for fascial closure following open abdominal management. ABTHERATM open abdomen NPWT provides significant advantages over traditional methods of TAC and may provide benefit in OA management in other patient groups (sepsis and trauma) as well.