Bogota Bag Research Articles

A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery

BackgroundTemporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital.MethodsA retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles.ResultsA total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3–3.8, p < 0.05).ConclusionIn patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.

Management of Diagnosed Abdominal Compartment Syndrome Using a Modified Bogota Bag Bedside Plication Technique

Malkoc, Aldin MD; Nguyen, Alexandra; Mac, Olivia MD; Wong, David T MD, FACS, FCCP Author Information

The Efficacy of VAMMFT Compared to "Bogota Bag" in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma

IntroductionThe open abdomen (OA) is a necessary component of damage control surgery and closure is often challenging. Our aim was to review our ten-year experience with OA in trauma patients and to compare the success of a dual closure technique termed vacuum-assisted, mesh-mediated fascial traction (VAMMFT) to an exclusively Bogota Bag (BB) approach.MethodsA retrospective analysis was performed using the HEMR database from 2012 to 2022, comparing demographics, mechanism of injury, admission vitals and biochemistry between patients with BB and VAMMFT applications. Rate of secondary abdominal closure and complications were assessed in both groups. Logistic regression was used to find predictors of closure.ResultsOA was required by 348 patients at index laparotomy. Of these, 133 (38.2%) were managed with VAMMFT and 215 (61.8%) exclusively with a BB. There were no statistical differences between the BB and VAMMFT groups in terms of demographics, injuries, admission vitals and biochemistry. The VAMMFT group achieved a closure rate of 73% compared to 54.9% in the BB group (OR of 2.2 [1.4–3.7]). There was no significant difference in fistulation rate between the two groups (p = 0.103). Length of hospital stay was 30 versus 17 days in the VAMMFT and BB groups, respectively (OR 1.41 [1.30–1.54]). There were no independent predictors of closure identified in the VAMMFT group. Older patients were less likely to achieve closure when BB was used (OR 0.97 [0.95–0.99]). VAMMFT failure was commonly due to lack of stock (39%) and protocol violations (33%).ConclusionThe VAMMFT approach to the OA is efficacious and safe. VAMMFT achieves a much higher rate of secondary closure than BB alone with a low rate of enteric fistula formation.

Invited Commentary: The Efficacy of VAMMFT Compared to "Bogota Bag" in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma.

Invited Commentary: The Efficacy of VAMMFT Compared to "Bogota Bag" in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma.

Primary Abdominal Tuberculosis Presenting as Peritonitis: Experience at an Emergency Medical Unit in the War Zone

Tubercular disease is a global health problem, but it is more prevalent in developing countries. Emergency surgery for complicated abdominal tubercular disease in a war zone is challenging as the confirmation of definite diagnosis is difficult and delayed. We are presenting a case of abdominal tubercular disease complicated with peritonitis from intestinal perforation in a young female, diagnosed as acute surgical abdomen, and undergone emergent exploratory laparotomy at a “Médecins Sans Frontières” (MSF) Emergency Medical Unit in the war zone of Lankien-South Sudan. She was managed with abdominal washouts and intestinal stoma; diseased tissues and ascitic fluid were taken for histopathology and cultures. A Bogota Bag was used for abdominal closure. The patient was timely but empirically put on anti-tubercular therapy, and she was transferred to a primary hospital on the 20th postoperative day to continue her treatment. We were informed that her primary abdominal tuberculosis was confirmed by histopathology from intraoperatively obtained tissues and she was doing well during a three-month follow-up.

Primary Abdominal Tuberculosis Presenting as Peritonitis: Experience at an Emergency Medical Unit in the War Zone

Tubercular disease is a global health problem, but it is more prevalent in developing countries. Emergency surgery for complicated abdominal tubercular disease in a war zone is challenging as the confirmation of definite diagnosis is difficult and delayed. We are presenting a case of abdominal tubercular disease complicated with peritonitis from intestinal perforation in a young female, diagnosed as acute surgical abdomen, and undergone emergent exploratory laparotomy at a “Médecins Sans Frontières” (MSF) Emergency Medical Unit in the war zone of Lankien-South Sudan. She was managed with abdominal washouts and intestinal stoma; diseased tissues and ascitic fluid were taken for histopathology and cultures. A Bogota Bag was used for abdominal closure. The patient was timely but empirically put on anti-tubercular therapy, and she was transferred to a primary hospital on the 20th postoperative day to continue her treatment. We were informed that her primary abdominal tuberculosis was confirmed by histopathology from intraoperatively obtained tissues and she was doing well during a three-month follow-up.

Intestinal perforation caused by Bogota bag: Case report

Intestinal perforation is generally characterized by the presence of any rupture or perforation of the intestine. As the gastrointestinal tract (GIT) is a major route for food, it can be damaged by internal causes or external causes. However improper use of Bogota Bag can lead to intestinal Perforation, then patients have gastrointestinal symptoms and complications that are associated with the high morbidity rate and mortality rate.

Open abdomen technique used in complications of major gynecological oncology surgery

To evaluate the open abdomen technique (laparostomy) used in complications of major gynecological oncology surgery. We analyzed retrospectively the surgical database of all patients who had undergone major open surgery by the same gynecologic oncologist over a 5-year period. All patients who had had open abdomen procedure were identified; demographic data and indications of primary surgery, temporary abdominal closure procedure details, fascia closure and morbidity, mortality rates were evaluated. Intraabdominal infection and intraoperative massive hemorrhage were the major indications for all open abdomen cases. Mannheim Peritonitis Index was used perioperatively to determine open abdomen decision in intraabdominal infections. Vacuum Assisted Abdominal Closure system and Bogota Bag were used for temporary abdominal closure techniques. Out of the total 560 patients who had undergone major oncological surgery, 19 patients (3.3%) had open abdomen procedure due to surgical complications. Eleven patients had intraabdominal infection, six patients had hemodynamic instability due to peri and postoperative hemorrhage, two patients had gross fecal contamination during posterior pelvic exenteration surgery. The fascia was closed totally in 15 (78%), partially in 3 (15%) and could not be closed in 1 patient who had died secondary to multiorgan failure. Total morbidity and mortality rates were 26% (5/19) (two intrabdominal abscess, one pulmonary embolism, one skin necrosis, one enteroatmospheric fistula) and 5.2% (1/19) respectively. Open abdomen is a life-saving procedure when applied with correct indications and timing. Gynecological oncologic surgeries are candidates to serious complications and gynecologic oncologists dealing with such surgery should be as experienced as general surgeons in this regard.

Negative pressure wound therapy for managing the open abdomen in non-trauma patients.

Management of the open abdomen is a considerable burden for patients and healthcare professionals. Various temporary abdominal closure techniques have been suggested for managing the open abdomen. In recent years, negative pressure wound therapy (NPWT) has been used in some centres for the treatment of non-trauma patients with an open abdomen; however, its effectiveness is uncertain. To assess the effects of negative pressure wound therapy (NPWT) on primary fascial closure for managing the open abdomen in non-trauma patients in any care setting. In October 2021 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL EBSCO Plus. To identify additional studies, we also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports. There were no restrictions with respect to language, date of publication, or study setting. We included all randomised controlled trials (RCTs) that compared NPWT with any other type of temporary abdominal closure (e.g. Bogota bag, Wittmann patch) in non-trauma patients with open abdomen in any care setting. We also included RCTs that compared different types of NPWT systems for managing the open abdomen in non-trauma patients. Two review authors independently performed the study selection process, risk of bias assessment, data extraction, and GRADE assessment of the certainty of evidence. We included two studies, involving 74 adults with open abdomen associated with various conditions, predominantly severe peritonitis (N = 55). The mean age of the participants was 52.8 years; the mean proportion of women was 39.2%. Both RCTs were carried out in single centres and were at high risk of bias. Negative pressure wound therapy versus Bogota bag We included one study (40 participants) comparing NPWT with Bogota bag. We are uncertain whether NPWT reduces time to primary fascial closure of the abdomen (NPWT: 16.9 days versus Bogota bag: 20.5 days (mean difference (MD) -3.60 days, 95% confidence interval (CI) -8.16 to 0.96); very low-certainty evidence) or adverse events (fistulae formation, NPWT: 10% versus Bogota: 5% (risk ratio (RR) 2.00, 95% CI 0.20 to 20.33); very low-certainty evidence) compared with the Bogota bag. We are also uncertain whether NPWT reduces all-cause mortality (NPWT: 25% versus Bogota bag: 35% (RR 0.71, 95% CI 0.27 to 1.88); very low-certainty evidence) or length of hospital stay compared with the Bogota bag (NPWT mean: 28.5 days versus Bogota bag mean: 27.4 days (MD 1.10 days, 95% CI -13.39 to 15.59); very low-certainty evidence). The study did not report the proportion of participants with successful primary fascial closure of the abdomen, participant health-related quality of life, reoperation rate, wound infection, or pain. Negative pressure wound therapy versus any other type of temporary abdominal closure There were no randomised controlled trials comparing NPWT with any other type of temporary abdominal closure. Comparison of different negative pressure wound therapy devices We included one study (34 participants) comparing different types of NPWT systems (Suprasorb CNP system versus ABThera system). We are uncertain whether the Suprasorb CNP system increases the proportion of participants with successful primary fascial closure of the abdomen compared with the ABThera system (Suprasorb CNP system: 88.2% versus ABThera system: 70.6% (RR 0.80, 95% CI 0.56 to 1.14); very low-certainty evidence). We are also uncertain whether the Suprasorb CNP system reduces adverse events (fistulae formation, Suprasorb CNP system: 0% versus ABThera system: 23.5% (RR 0.11, 95% CI 0.01 to 1.92); very low-certainty evidence), all-cause mortality (Suprasorb CNP system: 5.9% versus ABThera system: 17.6% (RR 0.33, 95% CI 0.04 to 2.89); very low-certainty evidence), or reoperation rate compared with the ABThera system (Suprasorb CNP system: 100% versus ABThera system: 100% (RR 1.00, 95% CI 0.90 to 1.12); very low-certainty evidence). The study did not report the time to primary fascial closure of the abdomen, participant health-related quality of life, length of hospital stay, wound infection, or pain. Based on the available trial data, we are uncertain whether NPWT has any benefit in primary fascial closure of the abdomen, adverse events (fistulae formation), all-cause mortality, or length of hospital stay compared with the Bogota bag. We are also uncertain whether the Suprasorb CNP system has any benefit in primary fascial closure of the abdomen, adverse events, all-cause mortality, or reoperation rate compared with the ABThera system. Further research evaluating these outcomes as well as participant health-related quality of life, wound infection, and pain outcomes is required. We will update this review when data from the large studies that are currently ongoing are available.

An Alternative Abdominal Closure Technique After Pediatric Liver Transplant: Bogota Bag Technique.

In conditions such as large-for-size syndrome, postreperfusion hepatic edema, and intestinal edema, primary closure of the abdominal wall can cause respiratory complications and thrombosis of vascular structures. Here, we compared results of primary abdominal closure versus a temporary patch closure technique (the Bogota bag technique) in pediatric liver transplant recipients. We performed primary abdominal closure in 295 recipients. In 39 pediatric liver transplant recipients, the Bogota bag technique was used as the abdominal closure technique because of suspected intraoperative tense abdominal closure. In patients who had the Bogota bag technique, we sutured the sterilized saline bag to the skin at the edge of the defect by shaping the defect so as not to cause abdominal hypertension. Primary abdominal closure was achieved in patients after control laparotomies at 48-hour intervals. The mean age of the primary abdominal closure group was 8.38 years, whereas the mean age of the Bogota bag group was 2 years. The average weight of patients in the primary abdominal closure group was 26.38 kg, and the average weight of patients in the Bogota bag group was 7.93 kg. Biliary atresia was the most common indication in both groups. Mean length of hospital stay was 21 days in the primary abdominal closure group and 24 days in Bogota bag group. Six patients in the Bogota bag group died from sepsis or bleeding in the early postoperative period. In the Bogota bag group, wound closure was achieved within 2 weeks in 25 patients and within 3 weeks in 8 patients. Temporary patch closure techniques can be used safely in low-weight and young children, children with large-for-size grafts, and those who display increased intra-abdominal pressure.

Outcome of Prophylactic Bogota Bag Application in Midline Laparotomy Wound Closure Versus Retention En Masse Closure Using Prolene Sutures in patients with Intra-Abdominal Hypertension

Aim: To compare the outcome of prophylactic bogota bag versus prolene retention sutures in patients with raised intra-abdominal pressure. Methodology: All the patients fulfilling the inclusion criteria presenting to emergency with the diagnosis of trauma, peritonitis and intestinal obstruction, were admitted as per protocol in south surgical unit, Mayo Hospital Lahore. Before laparotomy, their intra- abdominal pressure was measured using intra-vesical folleys catheter. Half of the closures were done using bogota bag and half closures using the prolene retention sutures. The patients were assessed for development of intra abdominal hypertension and wound dehiscence for a period of one week after their surgery. Results: Independent sample t test has applied to evaluate the difference between hospital length of stay between the patients treated with bogota bags and retention suture. The test was significant statistically i.e. p&lt;0.05.Chi square analysis was performed to evaluate the association between wound dehiscence and intra abdominal pressure treated with bogota bag and p&lt;0.05, hence the test was significant statistically. Conclusions: Bogota bag application is associated with lesser complications as compared to retention suture application in intra-abdominal hypertension. Keywords: Bogota bag, wound closure, midline laparotomy

Non-ICU-Based Staged Management of Laparotomy-Related Abdominal Compartment Syndrome in a 23-Year-Old Male

Introduction: Abdominal compartment syndrome (ACS) is a sustained intraabdominal pressure (IAP) of 20 mmHg or higher with new organ dysfunction. Decompression is required when IAP exceeds 25 mmHg even without evidence of organ dysfunction. Common abdominal surgical diseases and operations can be complicated by ACS, and clinicians should have the requisite capacity to detect and intervene early enough. Intensive care unit (ICU) care has traditionally been the mainstay of ACS management. Case Presentation: A 23-year-old male was referred with a combined mesh and Bogota bag anterior abdominal construct after a midline laparotomy 24 hours earlier, following which the abdominal wall could not be closed primarily without tension. This was the result of significant edema of the bowel and retroperitoneum. This patient, after adequate resuscitation, underwent a two-staged procedure, 6 days apart, to achieve skin closure. After an unremarkable skin healing, a mesh repair for the consequent incisional hernia was carried out 15 months later. Conclusions: This patient’s ACS was successfully managed in a non-ICU setting and could demonstrate the possibility of successfully managing selected cases of laparotomy-related ACS in low-resource settings without ICU facilities.

Successful Management of Abdominal Wound Dehiscence with Bogota bag, Vacuum assisted Closure combined with Tension Sutures

The burst abdomen management has advanced significantly. Here we present a management of a burst abdomen of morbid obese patient with combination of modality including Bogota bag, vacuum assisted closure and tension suturing. The patient underwent laparotomy for removal of sigmoid tumor with local infiltration and had wound dehiscence associated with infection, tissue oedema and necrosis. As patient was morbidly obese and had large wound gap, we decided to manage it with Bogota bag principal and Vacuum Assisted Closing. After successful formation of granulation tissue, we were able to apply tension sutures. Hence using combination of above-mentioned options, the patient was successfully sent back to his normal routines without any complication.

Comparison of negative-pressure wound therapy and Bogota bag technique in open abdomen: a retrospective clinical study

Comparison of negative-pressure wound therapy and Bogota bag technique in open abdomen: a retrospective clinical study

Hyperglycemia, Hypertriglyceridemia and Acute Pancreatitis in COVID-19 Infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primarily affects the respiratory tract, but gastrointestinal (GI) symptoms may obscure a secondary diagnosis. GI symptoms similar to the ones presented in acute pancreatitis (AP) have been reported. SARS-CoV-2 binds to angiotensin-converting enzyme 2 receptors, which have been identified in the lungs and pancreas. It has been discussed that systemic response to the infection prompts dysregulation in the affected organs. Hyperglycemia is an independent risk factor for increased mortality and thus a detailed assessment must be performed.A 47 year-old man with dyslipidemia arrived at the ER due to a severe constant epigastric pain of 1 day of evolution with back radiation associated with nauseas, emesis, and hyporexia. Upon examination he was tachycardic and in distress due to pain. Laboratories revealed normocytosis, normal hemoglobin, mild thrombocytopenia, hyperglycemia (150 mg/dL), corrected hyponatremia (130 mmol/L), and corrected hypocalcemia (7.4 mg/dL). Amylase (2,332 U/L) and lipase (2,990 U/L) were elevated. Triglycerides were 6,256 mg/dL and glycated hemoglobin was 6.1%. Abdominal CT scan revealed pancreatitis. He was admitted to the ICU due to severe AP due to hypertriglyceridemia with IV hydration and IV insulin infusion. During the first day of admission, he developed respiratory distress requiring intubation, marked abdominal distension, hemodynamic instability, and oliguria. Intra-abdominal pressure yielded 24 mmHg leading to the diagnosis of abdominal compartment syndrome. He underwent emergent abdominal decompressive laparotomy with Bogota Bag placement. COVID-19 PCR test was performed and reported positive. 72 hours later, triglycerides improved and IV insulin was discontinued, but hyperglycemic state prompted subcutaneous basal and correction boluses. Insulin requirement progressively decreased and was discontinued after 14 days. He continued to show clinical improvement and by day 40, the patient was successfully extubated and discharged after physical rehabilitation.SARS-CoV-2 infection has shown a complex multisystem involvement leading to variable presentations which can be fatal if not identified and addressed properly. Albeit, AP is a rare manifestation of COVID-19, clinicians should be aware and pay attention to the related complications. Proposed mechanisms for hyperglycemia and AP include β-cell damage. The pathogenetic role of COVID-19 in hypertriglyceridemia is unclear. Little attention has been paid to the extent of pancreatic injury caused by this virus. To our knowledge this is the second case presenting with hyperglycemia, hypertriglyceridemia, and AP in COVID-19 infection. As the global pandemic is still growing, elucidation of key pathways and mechanisms underlying these associations would aid in the treatment of patients with COVID-19 worldwide.

Comparative Evaluation of Various Methods of Drainage of the Abdominal Cavity in Patients with Secondary Bacterial Peritonitis

Background: Secondary peritonitis is a serious complication of all the inflammatory diseases and injuries of the abdominal organs and requires urgent surgical intervention. The mortality rate of patients with secondary bacterial peritonitis (SBP) reaches 70%. In some patients, despite the treatment, secondary peritonitis turns into tertiary peritonitis (TP), which complicates the healing process and aggravates the prognosis. Inadequate drainage of the abdominal cavity is a possible contributing factor to the formation of TP. Aims: A prospective study of the result of surgical treatment of patients with SBP was carried out to improve the results of treatment. Methods. The study included 608 patients with SBP who underwent surgery in a clinical hospital in Russia in 2013-2019. All the patients were divided into groups depending on the method of draining the abdominal cavity and on signs of the purulent process generalization, the marker of which was multiple organ failure. Efficiency of abdominal drainage (by the incidence of TP) and of treatment results (in terms of mortality) were assessed in each group. Results: In patients without signs of the purulent process generalization, drainage of the abdominal cavity with drainage tubes (293 observations) is accompanied by the development of TP in 4.1% of cases and by mortality in 22.9%. If the purulent process is of a generalized nature (315 observations), the incidence of TP increases ten-fold and is 41.9%, and the mortality rate increases 2.7 times and reaches 62.8%. With the generalization of the purulent process, the efficiency of drainage of the abdominal cavity has a significant impact on the results of surgical treatment of patients with SBP. If abdominal drainage is carried out with drainage tubes (129 observations), the incidence of TP is 41.9%, and the mortality rate is 62.8%. Drainage of the abdominal cavity using traditional laparostomy (Bogota bag, 104 cases) is accompanied by the development of TP in 36.5% of cases and mortality in 45.2%. If the abdomen is drained using active laparostomy (VAC-system, 82 observations), the incidence of TP is reduced to 18.3% and mortality to 19.5%. Conclusion. Drainage of the abdominal cavity is the most important stage of surgical intervention in patients with SBP. In cases of the purulent process generalization, drainage of the abdominal cavity in the most effective way– by active laparostomy (VAC-system) will improve the results of treatment of these patients.

Laporan Kasus: Stage Closure untuk Gastroskisis

Gastroschisis is a congenital defect of the anterior abdominal wall which is to the right of the umbilicus, gastric, small intestine and colon can be found outside the abdominal cavity. The incidence is 1: 2.500-10.000 births. The incidence of Gastroschisis in the world has increased in the last 30 years. In Indonesia, the incidence of Gastroschisis is not yet clear. The diagnosis is relatively easy by inspection and it is found that the contents of the abdomen are exposed outside the abdominal cavity. We reported a case of a baby patient aged six days when he was sent to Bagan Siapi Api Hospital and then performed the first stage operation, namely the installation of the bogota bag procedure, followed by gradual squist sac ligase treatment, after 18 days of treatment or at 37 days of age, devinitive surgery was performed close the abdominal wall defect

Hipertensão intra-abdominal secundária à ruptura diafragmática crônica em um cão

ABSTRACT: Intra-abdominal hypertension (IAH) is the persistent increase of intra-abdominal pressure (IAP) that could be caused by several pathologies. It is capable of promoting organ dysfunction, thereby increasing the mortality rate of human patients. As for cats and dogs, there are still few reports on how this pressure can be monitored and treated as a routine for admitted and hospitalized animals and on its relationship with the mortality of the patients. Therefore, the objective of this paper was to report a case of IAH secondary to chronic diaphragmatic rupture in a dog, which was treated with a temporary abdominal closure (TAC). A bitch was admitted to the veterinary hospital to undergo an elective ovariohysterectomy when it was diagnosed with a diaphragmatic rupture and displacement of the liver and intestinal loops in the chest. After repositioning these structures in the abdominal cavity, tension was observed in the abdomen. A temporary abdominal closure was then performed with a Bogota bag. Immediately after the surgery, the IAP was measured, presenting a value of 15 mmHg, indicating that there was an increase in intra-abdominal pressure. The animal was hospitalized, and IAP was monitored. After 24 hours, IAP was 5.8 mmHg when the Bogota bag was removed, and definitive celiorraphy was performed. The patient showed satisfactory clinical progress and was discharged 72 hours after the surgical procedure. The treatment used for IAH proved to be effective and contributed to the quick and satisfactory recovery of the patient.

POST LIVER TRANSPLANT INCISIONAL HERNIA MANAGEMENT

Aim: The development of incisional hernia (IH) following liver transplant (LT) comprises a potential complication. Here, we aimed to evaluate our postLT IH management. Materials and Methods: At our center, we use Mercedes incision in adults and bilateral subcostal incision in infants. We base closure of the abdomen according to perfusion of graft. All patients received methylprednisolone, tacrolimus and mycophenolate mofetil based immunosuppression. Results: Between December 1988 and December 2019 we performed 649 LT. To have a reasonable period, we evaluated 452 LT (207 pediatric, 245 adult). IH was diagnosed in 29 LT (6.4%) (7 pediatrics and 22 adults). Most of them were males (77%) with Child C cirrhosis (62%), moderate/severe ascites (81%) and serum albumin<3.5g/L (86%). IH were occured more in LT recipients with wound infection, body mass index of ≥ 30 kg/m2 and repeated surgery. We repaired IH in 22 adult LT (age range, 31-62 y); 5 primary repair and 17 with prolene mesh graft (3 sublay, 14 onlay). 3 seromas, 1 subcutaneous hemorrhage were seen during the early period of IH repair (18%). We had no other complications or recurrence during follow-up (range, 51-181 mo). Of 207 pediatric LT; 58 patients had body weight < 10 kg and GBWR > 4%. 18 pediatric LT had large-for-size grafts so we closed skin in 11 and abdomen with Bogota bag in 7. All abdomens with Bogota bags were closed in 2 weeks. IH repair was made in 7 pediatric patients after the first year of LT (range 12-15 mo,4-6 kg); 5 primary and 2 onlay mesh repair. None of these patients had any complications or recurrence during follow up (range, 55-103 mo) Conclusion: Even though the management of liver transplant complicated with incisional hernia is considered to be challenging, it can be handled successfully.

Cost evaluation of temporary abdominal closure methods in abdominal sepsis patients successfully treated with an open abdomen. Should we take temporary abdominal closure methods at face value? Health economic evaluation

BackgroundMany commercial and artisanal devices are utilized for temporary abdominal closure in patients being managed with an open abdomen for abdominal sepsis. The costs of materials required to treat patients with an open abdomen varies drastically. In Costa Rica, due to the lack of accurate information relating to the actual cost to manage a patient entails that the method with the least expensive materials is usually selected. Study designA single-center retrospective review of 46 patients diagnosed with abdominal sepsis and successfully treated with an open abdomen and one of the three temporary abdominal closure methods during the year 2018 in a tertiary hospital was evaluated using a gross-cost pricing model developed by the authors. The three temporary abdominal closure methods were a locally manufactured Bogota Bag, and commercial abdominal negative pressure therapy dressing and negative pressure therapy with 0.9% saline solution instillation. The per-unit-costs were hospital day and intensive care day, number of surgical procedures per patient, cost negative pressure therapy kits. ResultsStatistically significant cost reduction was observed in the cohort treated with negative pressure therapy with instillation as compared to the other temporary abdominal closure methods. The reduction of hospital length of stay, as well as fewer number of surgeries were the main contributing factors in diminishing costs. On average, the costs to treat a patient utilizing negative pressure therapy with instillation was nearly 50% lower than using the other two temporary abdominal closure methods. ConclusionsThe costs relating to managing abdominal sepsis in the septic open abdomen vary greatly according to the temporary abdominal closure utilized. If the hospital length of stay, intensive care unit length of stay and number of surgeries required are the main parameters used in determining costs, the use of negative pressure therapy with 0.9% saline solution instillation reduces costs by nearly 50% in comparison to conventional negative pressure wound therapy and Bogota Bag. In this instance, the more expensive method at first glance, obtained a considerable cost reduction when compared to therapies that utilize less expensive materials.