The modified sandwich-vacuum package for fascial closure of the open abdomen in septic patients with gastrointestinal fistula

Abstract

Numerous temporary abdominal closure (TAC) techniques have been described in treatment of the open abdomen. However, data confirming their role in the management of gastrointestinal fistula complicated with abdominal sepsis are limited. This retrospective study evaluated whether a modified sandwich-vacuum package (MSVP) improved fascial closure rate compared with the polypropylene mesh (PPM)-mediated method. Patients, who experienced gastrointestinal fistula and underwent open abdomen management, were included and divided into MSVP and PPM groups according to the TAC method they received. Mortality, fascial closure rate, postoperative complications, and other outcomes were compared between the two groups. Between 2000 and 2010, 36 patients were treated with MSVP, with 36 cases for PPM. The overall mortality after a TAC procedure was 22.2% and 44.4%, respectively (p = 0.079). Compared with PPM technique, the fascial closure rate under MSVP method was markedly increased (63.9% vs. 33.3%, p = 0.018). Moreover, time to definitive closure (p = 0.003), length of stay in hospital (p = 0.042), and hospital charges (p = 0.001) were significantly decreased. Postoperative fistula was recorded in five patients, with one case from the PPM group developing enteroatmospheric fistula. None of the complications had statistical difference. Early enteral nutrition (EEN) was successfully applied in 36 patients, with 19 cases from the MSVP group. The application of MSVP (odds ratio, 4.889; 95% confidence interval, 1.518-15.746) and EEN (odds ratio, 5.691; 95% confidence interval, 1.662-19.474) were independent predictors of successful fascial closure. The use of MSVP after open abdomen was feasible in septic patients with gastrointestinal fistula. MSVP, together with EEN therapy, should be recommended for such populations.