Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

Kääriäinen, Minna; Kuuskeri, Marika; Helminen, Mika; Kuokkanen, Hannu

doi:10.1177/1457496916665542

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…Regarding the closure of an open abdomen, both the synthetic mesh-mediated fascial traction in combination with NPT has been advocated, with currently the best outcomes reported, as well as the use of (resorbable) meshes as an adjunct to primary fascial closure during OA management. Four observational studies ( 33 – 36 ) reported on using mesh at the time of primary fascial closure. Regarding the presence of an incisional hernia, all together, 98 patients were studied with an incidence of incisional hernias of around 20%.…”

Section: Prevention Of Incisional Hernia Development After Oa Managemmentioning

confidence: 99%

Prevention of Incisional Hernias after Open Abdomen Treatment

Berrevoet

2018

Front. Surg.

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Management of a patient with an open abdomen is difficult, and the primary closure of the fascial edges is essential to obtain the best patient outcome, regardless of the initial etiology of the open abdomen. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with mesh-mediated fascial traction as the proposed standard of care. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. As shown for other high-risk patient subgroups, such as obese patients, patients with an abdominal aneurysm, and patients with former -ostomy sites, the prevention of incisional hernias might be key to further optimize patient outcomes after open abdomen treatment. In this overview, current available modalities to decrease the incidence of incisional hernia are discussed. Most of these preventive options have been shown effective in giant ventral hernia repair and might work effectively in this patient cohort with open abdomen as well.

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Section: Prevention Of Incisional Hernia Development After Oa Managemmentioning

confidence: 99%

Prevention of Incisional Hernias after Open Abdomen Treatment

Berrevoet

2018

Front. Surg.

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“…Eleven articles were included for qualitative synthesis. Complementary data from three studies [8,12,13] was collected after correspondence. Since no RCTs comparing VAWCM with other TAC techniques were identified, there was no basis on which to perform a meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

“…In 2007, the first report of a modified technique combining vacuum-assisted wound closure with mesh-mediated fascial traction (VAWCM) for long-term therapy of the open abdomen was published [5]. Since then, several centres have adopted this technique and reported their experiences [6][7][8][9][10][11][12][13][14][15]. The aim of this systematic review was to report the short-term and long-term results for the VAWCM technique.…”

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confidence: 99%

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy — a systematic review

Acosta¹,

Björck²,

Petersson³

2017

Anaesthesiol Intensive Ther

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Background: The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. Methods: A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Results: Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. Conclusions: A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

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“…Of the 15 articles included, 6 were prospective (3, 9-13) and 9 were retrospective (2,(14)(15)(16)(17)(18)(19)(20)(21). No study was randomized, and most studies were observational with only one treatment group.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…No study was randomized, and most studies were observational with only one treatment group. Four reports (15,18,19,21) included other techniques beside VAWCM, from which the VAWCM results were extracted. The study populations ranged between 7 and 111 with a mean of 40, and 600 patients were totally included (2, 3, 9-21).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Dynamic Fascial Closure With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction (VAWCM) Treatment of the Open Abdomen—An Updated Systematic Review

Petersson

2020

Front. Surg.

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Introduction: Several different temporary abdominal closure techniques are described in the context of open abdomen treatment. Techniques based on dynamic fascial closure combined with negative pressure therapy have gained popularity and seem to result in the highest fascial closure rates without increased complications and are highlighted in recent guidelines and recommendations. One dynamic closure technique is the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique, first described in 2007. The aim of this systematic review was to evaluate the VAWCM technique regarding a number of short-and long-term results. Materials and Methods: A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library databases for articles published between January 1, 2006 and May 8, 2020. The review was independently performed by the two authors according to the PRISMA statements for reporting systematic reviews and meta-analyses. Results were pooled for presentation of weighted means when applicable. Results: A total of 220 articles were screened by title and abstract. Thirty-two articles were assessed for eligibility by full-text review and 15 articles finally remained for review. A total of 600 patients treated with VAWCM were included. The pooled weighted means were as follows: fascial closure, 83.5%; enteroatmospheric fistula, 5.6%; planned ventral hernia, 6.2%; in-hospital survival, 72%; and incisional hernia incidence, 40.5%. Long-term survival ranged between 22 and 72%. Quality of life (SF-36) was reported in two studies showing lower scores than the population mean especially in physical domains. Incisional hernia resulted in lower scores in one but not in the other study. Discussion: The results of 600 VAWCM-treated patients from 15 studies were evaluated in this systematic review. Earlier findings with high fascial closure rates, low Petersson and Petersson VAWCM-An Updated Systematic Review enteroatmospheric fistula, and planned ventral hernia rates as well as high incisional hernia incidences were underlined. Permanent mesh for efficient fascial traction and reinforcement at fascial closure seem to be the next step in evolving an optimal temporary closure technique in open abdomen treatment.

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Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

Cited by 11 publications

References 20 publications

Prevention of Incisional Hernias after Open Abdomen Treatment

Prevention of Incisional Hernias after Open Abdomen Treatment

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy — a systematic review

Dynamic Fascial Closure With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction (VAWCM) Treatment of the Open Abdomen—An Updated Systematic Review

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