Method Of Temporary Abdominal Closure Research Articles

The temporary abdominal closure techniques used for trauma patients: a systematic review and meta-analysis.

The choice of temporary abdominal closure (TAC) method affects the prognosis of trauma patients. Previous studies on TAC are challenging to extrapolate due to data heterogeneity. We aimed to conduct a systematic review and comparison of various TAC techniques. We accessed web-based databases for studies on the clinical outcomes of TAC techniques. Recognized techniques, including negative-pressure wound therapy with or without continuous fascial traction, skin tension, meshes, Bogota bags, and Wittman patches, were classified via a method of closure such as skin-only closure vs. patch closure vs. vacuum closure; and via dynamics of treatment like static therapy (ST) vs. dynamic therapy (DT). Study endpoints included in-hospital mortality, definitive fascial closure (DFC) rate, and incidence of intraabdominal complications. Among 1,065 identified studies, 37 papers comprising 2,582 trauma patients met the inclusion criteria. The vacuum closure group showed the lowest mortality (13%; 95% confidence interval [CI], 6%-19%) and a moderate DFC rate (74%; 95% CI, 67%-82%). The skin-only closure group showed the highest mortality (35%; 95% CI, 7%-63%) and the highest DFC rate (96%; 95% CI, 93%-99%). In the second group analysis, DT showed better outcomes than ST for all endpoints. Vacuum closure was favorable in terms of in-hospital mortality, ventral hernia, and peritoneal abscess. Skin-only closure might be an alternative TAC method in carefully selected groups. DT may provide the best results; however, further studies are needed.

Simple suture whipstitch closure is a reasonable option for many patients requiring temporary abdominal closure for blunt or penetrating trauma

ObjectivesMultiple temporary abdominal closure (TAC) techniques are currently used to manage the open abdomen (OA) in severely injured trauma patients, with variability in efficacy and cost. We evaluated the clinical...

Overview on Temporary Abdominal Closure Techniques: A Review

Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.

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 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.

Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Emergency and Trauma Surgery.

According to the UEMS (Union Europeene des Medicins Specialises) Section of surgery Board of Surgery, "Emergency Surgery" can be defined "as surgery that is required to deal with an acute threat to life, organ, limb or tissue caused by external trauma, acute disease process, acute exacerbation of a chronic disease process, or complication of a surgical or other interventional procedure". Performance of emergency surgery require complex and varied skills and abilities to achieve procedures from different fields of surgery: abdominal, urologic, thoracic, vascular, soft tissue, skeletal) within an interval of 24 hours (1). In U.S., since 2008, Acute Care Surgery concept was introduced, and nowadays is an evolving specialty with three essential components- trauma, critical care and emergency surgery (2). In UK there is an increasing subspecialisation within general surgery over the last ten years. More recently, there has been an increase in focus on emergency general surgery (3,4). This may not come as a surprise given the fact that trafic crashes kill 1.2 million people annually around the world (3242 people/day) and 90% are in middle and low income countries. In US trauma is the leading cause of death in persons up to 40 years. Optimal care for emergency surgical patients is one of the major challenges for every healthcare system worldwide. An emergency surgery mai intervene during the daily schedule of elective interventions and create pressure on both the organisation and costs (5). Since it's birth, in 2007, the Romanian Society for Emergency Surgery and Trauma was involved in supporting the development of practice in emergency surgery in Romania by many actions: each year, during biannual National Congres and National Conference of the Romanian Society of Surgery 2 sessions were dedicated to emergency surgery, with invited foreign speakers; oragnisation of European Congres of Emergency and Trauma Surgery in 2017 in Bucharest, 1 tematic issue of Chirurgia Journal dedicated to surgery of the cirrhotic patients. This tematic isssue includes varia subjects from emergency surgery in valuable articles. The management of open abdomen management are depicted by Anastasiu et al, in a review summarizing definition, classification, indications, methods of temporary abdominal closure and fascial closure, and enterocutanous fistula. Turculet et al, perfomed a review of the litterature to describe the main advantages and disadvantages of the trauma systems in Europe and to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. A rare case of small bowel hemangioma with hemoperitoneum mimicking trauma is described by Iordache et al, with a review of the litterature. The series of reviews ends with an interesting article for daily practice in emergency hospitals about the diagnostic and therapeutic peculiarities in abdominal trauma associated with spinal cord injurie by Grigorean et al. Abdominal trauma is addressed in 7 original papers. The definitive surgery for liver trauma in tertiary HPB center, the nonoperative treatment of abdominal trauma involving liver and spleen, the timing of splenic interventional radiology, the management of colon trauma at a level II trauma, challenges raised by the retroperitoneal hematoma in abdominal trauma, predicition of evolution of patients with abdominal trauma using the usual biological parameters, and clinico-pathological correlations in the acute surgical abdomen in the pre and post COVID-19 pandemic period are presented, analysed and discussed in papers coming from specialized surgical units from Fundeni Clinical Institute, Emergency Clinical Hospital Bucharest, Emergency University Hospital of Bucharest, "Bagdasar-Arseni" Clinical Emergency Hospital, "St. Pantelimon" Clinical Emergency Hospital, Clinical County Emergency Hospitals of Craiova and Tg-Mures. The surgical technique of intraomental splenic implant and an attempt of reassessement is presented in a paper by Beuran et al. We hope that this tematic issue will be an interesting and very useful lecture for our readers and bring useful informations for those involved in emergency surgery.

The Management of the Open Abdomen - A Literature Review.

An essential component of the concept of "Damage control surgery", laparostomy is the procedure by which the abdomen is deliberately abandoned open, the visceroperitoneal contents being temporarily protected by multiple technical means. Actual classification: Grade 1, without viscero-parietal adhesions or fixity of the abdominal wall (lateralization), divided into: 1A clean, 1B contaminated and 1C enteral fistula -cutaneous skin is considered clean); Grade 2, which develops fixation is subdivided into: 2A clean, 2B contaminated and 2C enteral fistula; Grade 3, "frozen abdomen", is divided into: 3A clean and 3B contaminated; Grade 4, defined as enteroatmospheric fistula, is a permanent fistula associated with the presence of granulation tissue and a frozen abdomen. Indications of the open abdomen are: damage control surgery, abdominal compartment syndrome, peritonitis, severe acute pancreatitis, vascular emergencies. Temporary abdominal closure may be achieved by following methods: skin only closure, â??Bogota bagâ?Â, opsite Sandwich technique, absorbable mesh, non-absorbable mesh or commercial zipper, vaccum asisted closure, each with its own advantages and disadvantages. Regarding the definitive closure this can be achieved by non mesh and mesh mediated techniques. Component separation technique anterior and posterior should be considered the elective repair procedure in parietal defects after laparostomy. Although several studies have been published, there is still no consensus in the literature on the positioning of prosthetic material in relation to parietal planes. Some authors suggest better results (relative to the rate of recurrence and complications) for implantation in the "sublay" position. Open abdomen is an important tool in the arsenal of the emergency surgery. Classification, indications, methods of temporary abdominal closure are evolving, as well as management of enterocutaneous fistulas and fascial closure, therefore permanent update is neccessary to offer patients the best care.

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.

Single hem to reduce evisceration following Bogotá bag for damage control surgery: ‘sail technique’

Laparostomy reduces complications of intra-abdominal hypertension and allows for planned relook procedures.[1][1] Temporary abdominal closure techniques have transformed damage control surgery. Mattox described Bogotá bags as an early method of...

Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen.

The open abdomen technique is a surgical strategy used in life-threatening conditions. After recognizing the morbidity and mortality attributed to abdominal compartment syndrome (ACS), several methods were developed to avoid this complication. The primary goal of temporary abdominal closure (TAC) is to create a tension-free closure of the abdomen without increasing intra-abdominal pressure. The optimal method of TAC should contain and protect the contents of the peritoneal cavity from external contamination and injury, preserve fascia; minimize desiccation and damage to viscera, remove and quantify third space fluid; prevent loss of domain, lower bacterial count, inflammatory response, keep the patient's abdominal wall skin dry and intact; preserve the integrity of the abdominal wall, be simple to perform and maintain, provide ease of reentry and have minimal adverse physiologic effects. Negative pressure wound therapy allowed the TAC method to achieve these objectives, but the presence of enteric fistulas or entero-atmospheric fistulas is still a challenge for even the most experienced surgeon. Here we describe two new alternatives to manage the septic complex abdomen with entero-atmospheric fistula.

Negative pressure temporary abdominal closure without continuous suction: a solution for damage control surgery in austere and far-forward settings

The use of topical negative pressure dressings in temporary abdominal closure has been readily adopted worldwide; however, a method of continuous suction is typically required to provide a seal. We...

Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen.

Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated. In the study, the temporary abdominal closure methods of the patients with OA during 2013-2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared. The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05). In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

A case of spontaneous bladder rupture following vaginal delivery in a mutilated woman

Background: Female genital mutilation/cutting (FGM/C) is applied to more than 130 million women in the world with long-term complications of pain, dyspareunia, difficulty in urination, recurrent urinary tract infection, vesicovaginal fistula, and obstetric morbidities. The authors present a case of spontaneous bladder rupture following vaginal delivery in a genital mutilated pregnant woman, which has not been reported in the literature previously. Case Report: A 31-year old age primigravid woman presented on postpartum 6th day with abdominal distention, ileus, dyspnea, and acute renal failure. After physical and radiological examination with laboratory analysis the initial diagnosis was intra-abdominal sepsis. During laparotomy, disseminated abscess formation and massive urinary leakage from ruptured bladder wall was observed. After bladder repair, open abdomen procedure was performed to control abdominal infection. Vacuum- assisted closure therapy was applied as a temporary abdominal closure method. The patient was discharged from the hospital with no complications on the 14th day. Conclusion: This case report shows that genital mutilation can lead to genitourinary system injuries and is one of the etiologic factors of spontaneous bladder rupture during vaginal delivery.

Does Negative-Pressure Wound Therapy for the Open Abdomen Benefit the Patient? A Retrospective Cohort Study.

Negative-pressure wound therapy (NPWT) is the most modern and sophisticated method of temporary abdominal closure. The aim of the study was to determine the significant predictors for mortality in patients with NPWT. University Clinical Centre Maribor, Slovenia MATERIALS AND METHODS:: The authors performed a retrospective cohort study of all patients treated with NPWT between January 1, 2011, and December 31, 2014. In the univariate analysis, the type of wound closure, more than 7 NPWT changes, the total days with NPWT, and time to wound closure were significantly associated with death of the patient. In the multivariate analysis, only the number of more than 7 NPWT changes was found as a significant predictor for death (P = .038). Negative-pressure wound therapy is a method of choice for the treatment of open abdomen if there is a clear indication. However, clinicians should try all measures to remove the NPWT system and close the abdomen as soon as possible because prolonged use is associated with significantly higher mortality.

Hemorheological factors can be informative in comparing treatment possibilities ofabdominal compartment syndrome.

Abdominal compartment syndrome (ACS) is alife-threatening condition, of which pathomechanism hasn't been completely clarified, yet. Furthermore, surgical therapy still needs optimization. We aimed to investigate microcirculatory and micro-rheological alterations in ACS, using various temporary abdominal closure methods, including three settings of vacuum-assisted closure technique (negative pressure wound therapy, NPWT). On anesthetized pigs, by intraabdominally placed and filled-up silicone bags, intraabdominal pressure at 30 mmHg was maintained for 3hours, and afterwards, decompressive laparotomy happened. In different experimental groups Bogota-bag or Vivano abdominal sets were applied (-50, -100, -150 mmHg) for 2hours. Pressure monitoring was done by implanted sensors, hemorheological parameters were determined, and laser Doppler flowmetry tests were performed on the surface of intraabdominal organs. Treatment with Bogota-bag and -150 mmHg vacuum increased erythrocyte aggregation, while deformability declined. Blood viscosity increased after treatment with -150 mmHg vacuum. The microcirculatory parameters of the NPWT groups were better in small intestine. ACS resulted in impairment of macro- and micro-rheological parameters and abdominal organs' microcirculation. All of the used techniques improved the results, however, applying Bogota-bag or -150 mmHg vacuum set showed worse microcirculatory and micro-rheological data than the settings at -100 or -50 mmHg.

Temporary Vacuum-Assisted Closure of the Open Abdomen in Neonates.

Introduction The need for open abdomen in the treatment of severely ill neonates will increase in time as more complex abdominal procedures are undertaken. However, the experience of temporary closure of an open abdomen using vacuum-assisted closure (VAC) system is still relatively limited in premature and term neonates. The aim of this study is to describe and review our experience in the use of temporary VAC of the open abdomen for neonates with varying pathological processes. Materials and Methods A retrospective folder review of all neonates treated with VAC for open abdomen over the study period of 2010 to 2014 at our institution was performed. Results A total of 15 neonates were included in this study. Mean gestational age and postbirth age at VAC application were 33.6 ± 4.1 (28-40) weeks and 14 ± 10.2 (2-30) days, respectively. Mean weight at VAC application was 1,797.7 ± 730.8 (960-3,200) g. Initial diagnoses were necrotizing enterocolitis (seven), intestinal perforation (three), gastroschisis (two), congenital diaphragmatic hernia (two), and primary abdominal compartment syndrome (ACS) (one). Reasons for VAC application included confirmed ACS (2) and application to prevent ACS (13). Duration of VAC use was 4 ± 3.4 (0-13) days during which 2 ± 1.2 (1-5) applications were performed. Overall survival rate was 80% (12 of 15 patients). One patient with primary ACS died from sepsis with an open abdomen. The only potential VAC-related complication was an enterocutaneous fistula. Conclusion Temporary VAC of the open abdomen is a safe method of temporary abdominal closure to prevent ACS in high-risk postoperative conditions in neonates of any gestational age and birth weight.

Optimum Methods for Keeping the Abdomen Open

Damage control laparotomy, also known as an “open abdomen,” is a life-saving maneuver frequently used to treat severely injured and emergency general surgery patients. Several techniques exist to keep the abdomen open; temporary abdominal closure methods have evolved over time from inexpensive, simple techniques to more advanced methods utilizing commercially available products with improving results. In this review, we describe the techniques of open abdomen management along with their advantages and drawbacks as well as advanced management of patients with open abdomens.

What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis.

The open abdomen technique may be used in critically ill patients to manage abdominal injury, reduce the septic complications, and prevent the abdominal compartment syndrome. Many different techniques have been proposed and multiple studies have been conducted, but the best method of temporary abdominal closure has not been determined yet. Recently, new randomized and nonrandomized controlled trials have been published on this topic. We aimed to perform an up-to-date systematic review on the management of open abdomen, including the most recent published randomized and nonrandomized controlled trials, to compare negative pressure wound therapy (NPWT) with no NPWT and define if one technique has better outcomes than the other with regard to primary fascial closure, postoperative 30-day mortality and morbidity, enteroatmospheric fistulae, abdominal abscess, bleeding, and length of stay. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions, an online literature research (until July 1, 2015) was performed on MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Library databases. The MeSH terms and free words used "vacuum assisted closure" "vac;", "open abdomen", "damage control surgery", and "temporary abdominal closure". No language restriction was made. The initial systematic literature search yielded 452 studies. After a careful assessment of the titles and of the full text was obtained, eight articles fulfilled inclusion criteria. We analyzed 1,225 patients, of whom 723 (59%) underwent NPWT and 502 (41%) did not undergo NPWT, and performed four subgroups: VAC versus Bogota bag technique (two studies, 106 participants), VAC versus mesh-foil laparostomy (two studies, 159 participants), VAC versus laparostomy (adhesive impermeable with midline zip) (one study, 106 participants), and NPWT versus no NPWT techniques (three studies, 854 participants) in which it is not possible to perform an analysis of the different types of treatment. Comparing the NPWT group and the group without NPWT, there was no statistically significant difference in fascial closure (63.5% vs 69.5%; odds ratio [OR], 0.74; 95% confidence interval [CI], 0.27-2.06; p = 0.57), postoperative 30-day overall morbidity (p = 0.19), postoperative enteroatmospheric fistulae rate (2.1% vs 5.8%; OR, 0.63; 95% CIs, 0.12-3.15; p = 0.57), in the postoperative bleeding rate (5.7% vs 14.9%; OR, 0.58; 95% CIs, 0.05-6.84; p = 0.87), and postoperative abdominal abscess rate (2.4% vs 5.6%; OR, 0.42; 95% CI, 0.13-1.34; p = 0.14). On the other hand, statistical significance was found between the NPWT group and the group without NPWT in the postoperative mortality rate (28.5% vs 41.4%; OR, 0.46; 95% CI, 0.23-0.91; p = 0.03) and in the length of stay in the intensive care unit (mean difference, -4.53; 95% CI, -5.46 to 3.60; p < 0.00001). The limitations of the present analysis might be related to the lack of randomized controlled trials, so there is a risk of selection bias favoring NPWT. For several outcomes, there were few studies, confidence intervals were wide, and inconsistency was high, suggesting that although there were no statistically significant differences between the groups, there was insufficient evidence to show that the outcomes were similar. We can conclude from the current available data that NPWT seems to be associated with a trend toward better outcomes compared to the use of no NPWT. It does reflect the evidence presented in the current systematic review; however, the data should be interpreted with substantial caution given a number of weaknesses (in particular, the lack of statistical significance and heterogeneity between studies, i.e., small sample size of the included studies, high variability between studies). We highlight the need for randomized controlled trials having homogeneous inclusion criteria to assess the use of NPWT for the management of open abdomen. Systemic review/meta-analysis, level III.

Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon.

Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included.

Open abdomen in trauma patients: a double-edged sword.

The use of open abdomen (OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19th century. Since the 1980s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula (EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure (TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy (NPT) is the most commonly used TAC method.