Complications and Mortality Associated with Temporary Abdominal Closure Techniques: A Systematic Review and Meta-Analysis

Abstract

Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov. All studies describing TAC technique use in the open abdomen were eligible for inclusion. Data were analyzed per TAC technique in the form of a meta-analysis. A total of 225 articles were included in the final analysis. A meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure [mean difference (MD): 35% ± 23%; P = 0.0044]. A subsequent meta-analysis involving all included studies confirmed its superiority across outcomes for definitive fascial closure (MD: 19% ± 3%; P < 0.0001), perioperative (MD: -4.0% ± 2.4%; P = 0.0013) and in-hospital (MD: -5.0% ± 2.9%; P = 0.0013) mortality, entero-atmospheric fistula (MD: 22.0% ± 1.8%; P = 0.0041), ventral hernia (MD: -4.0% ± 2.4%; P = 0.0010), and intra-abdominal abscess (MD: -3.1% ± 2.1%; P = 0.0044). Therefore, it was concluded that NPWT with continuous fascial traction is superior to NPWT alone.

Einsatz der Vakuuminstillationstherapie für die Wundbehandlung – Ergebnis einer Expertenkonsensuskonferenz

“…Basierend auf der bereits seit vielen Jahren etablierten NPWT [16][17][18][19][20][21][22][23][24], die meist als Methode der temporären Weichteildeckung zur Wundbettpräparation in der Überbrückung bis zu einem abschließenden Wundverschluss eingesetzt wird, wurde die Modalität einer zusätzlichen Instillationstherapie mit steuerbarer Einwirkzeit entwickelt.…”

Combing a novel device and negative pressure wound therapy for managing the wound around a colostomy in the open abdomen

“…Literature retrieval found a meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure. [14] Therefore, it was concluded that NPWT does effectiveness in deal with OA.…”

Open abdomen in acute mesenteric ischemia

“…In two recent systematic reviews with metaanalyses [27,28] on OA and TAC techniques, NPWT with continuous fascial traction was associated with a higher delayed fascial closure rate and lower entero-atmospheric fistula formation rate compared to NPWT alone. This emphasizes the importance of having an effective method to close the abdomen as quickly as possible to reduce the risk of complications associated with OA therapy.…”