Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction

Acosta, Stefan; Bjarnason, Thordur; Petersson, Ulf; Pålsson, Birger; Wanhainen, Anders; Svensson, Mats; Djavani, Khatereh; Björck, Martin

doi:10.1002/bjs.7383

Cited by 195 publications

(189 citation statements)

References 27 publications

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“…On the other hand, it is known that a BM is also unlikely to perform well in case of a heavy (continuous) bacterial load. In these cases, it has been proposed to decrease the bioburden and control the source of sepsis by repetitive reentry and abdominal lavage in order to downgrade the wound to a grade of contamination, before using a mesh for abdominal wall closure, if any [28]. Although the final closure of the abdomen is likely to be a good indication for a BM, some authors have advocated the use of (megaporous) polypropylene mesh in those circumstances with acceptable results.…”

Section: Clinical Outcome Of Synthetic Meshesmentioning

confidence: 99%

The battle between biological and synthetic meshes in ventral hernia repair

Montgomery

2013

Hernia

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Section: Clinical Outcome Of Synthetic Meshesmentioning

confidence: 99%

The battle between biological and synthetic meshes in ventral hernia repair

Montgomery

2013

Hernia

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“…From a therapeutic perspective, the majority of patients with extensive mesenteric embolization, especially those with intestinal infarctions, were managed with explorative laparotomy, open abdomen therapy and damage control principles [12]. Stomas were used with a low threshold in order to minimize the risks of bowel leakage, the breakdown of an anastomosis, and late perforations.…”

Section: Discussionmentioning

confidence: 99%

Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention — a nested case control study

Acosta

Kärkkäinen

2017

Anaesthesiol Intensive Ther

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Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.

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“…7 In this paper we assessed prospectively 27 patients, after continuation No matter what type of sequential mechanism for closure of OA is used, whether these are dynamic compression sutures (DCS), static compression sutures (SCS), polypropylene meshes in terms of SMAC -sandwich mesh abdominal closure, 10 or commercially made systems (ABRA system, Canica Medical Products Inc., Ontario, Canada), they showed significantly higher ratio of possible fascia closure in patients with OA. [11][12][13][14][15][16][17][18][19] In our group the most commonly used fixation were static sutures (37.5%), in 39.5% of patients no fixation was used. If considering relative numbers, more than half of the patients with ACS (26% of all patients) had no fixation.…”

Section: Frommentioning

confidence: 99%

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

Bartko

Prochotský

Sekac

et al. 2016

NPWTJ

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Abstract-Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI).Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure. Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant.Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

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Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction

Abstract: The VAWCM method provided a high fascial closure rate after long-term treatment of OA. Technique-related complications were few. No patient was left with a large planned ventral hernia.

Cited by 195 publications

References 27 publications

The battle between biological and synthetic meshes in ventral hernia repair

The battle between biological and synthetic meshes in ventral hernia repair

Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention — a nested case control study

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

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