Vacuum Assisted Mesh Mediated Fascial Traction Is Effective at Achieving Secondary Closure of Open Abdomens Following Emergency Laparotomy in a Developing World Setting

Abstract

Introduction: We have previously described our initial experience with a combination approach known as Vacuum Assisted Mesh Mediated Fascial Traction (VAMMFT). This project reviews our two-year experience with the use of VAMMFT following TAC in patients undergoing an emergency laparotomy. Methods: All patients who could not undergo primary closure at index laparotomy and who required a TAC and subsequently a VAMMFT were identified from Hybrid Electronic Medical Registry (HEMR) and retrieved for analysis. Results: Over the two year period January 2017- January 2019, a total of 77 patients required a VAMMFT following an emergency laparotomy. Of this cohort 15 (19%) died and 62 survived. Of the 15deaths two achieved SFC prior to death and 13 died with a VH. Of the 62 who survived SFC was achieved in 46/62 (74%) and 16/62 (25%) were left with a VH. The overall rate of SFC was 48/77(62%). The median length of stay was 29 days, the median number of repeat laparotomies was4, and median time to first repeat laparotomy was 3 days. A total of 19 patients (32,2%) required ICU admission. The VH group had a significantly longer length of hospital stay than the SFC group. The following morbidities were recorded, anastomotic failure, intra-abdominal sepsis(13), acute kidney injury (8), hospital acquired pneumonia (6) and enteric fistulae (7). Conclusion: VAMMFT seems to both safe and efficacious in our environment. There are no absolute or well defined contraindications to its use. We must continue to audit it’s use to better refine our management strategies going forward.