Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Catena, Fausto; Ceresoli, Marco; Kluger, Yoram; Kirkpatrick, A. W.; Montori, Giulia; Salvetti, F; Fugazzola, Paola; Tomasoni, Matteo; Sartelli, Massimo; Ansaloni, Luca; Catena, Fausto; Negoi, Ionuț; Zese, Monica; Occhionorelli, Savino; Shlyapnikov, S.A.; Galatioto, Christian; Chiarugi, Massimo; Demetrashvili, Zaza; Dondossola, Daniele; Ioannidis, Orestis; Novelli, Giuseppe; Nacoti, Mirco; Khor, Desmond; Inaba, Kenji; Δημητριάδης, Δημήτριος; Kaussen, Torsten; Jusoh, Asri Che; Ghannam, Wagih; Sakakushev, Boris; Guetta, Ohad; Dogjani, Agron; Costa, Stéfano; Singh, Sandeep; Damaskos, Dimitrios; Işık, Arda; Yuan, Kuo Ching; Trotta, Francesco; Rausei, Stefano; Martínez‐Pérez, Aleix; Bellanova, Giovanni; Fonseca, Vinicius Cordeiro; Hernández, Fernando; Marinis, Athanasios; Fernandes, Wellington; Quiodettis, Martha; Bala, Miklosh; Vereczkei, András; Curado, Rafael; Fraga, Gustavo Pereira; Pereira, Bruno M.; Gachabayov, Mahir; Chagerben, Guillermo Perez; Arellano, Miguel León; Ozyazici, Sefa; Costa, Gianluca; Tezcaner, Tugan; Porta, Massimiliano Della; Li, Yousheng; Karateke, Faruk; Manatakis, Dimitrios K.; Mariani, Federico; Lora, Federic; Sahderov, Ivan; Atanasov, B.; Zegarra, Sergio; Gianotti, Luca; Fattori, Luca; Ivatury, Rao R.

doi:10.1016/j.injury.2018.09.040

Cited by 62 publications

(52 citation statements)

References 27 publications

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“…To base open abdomen management on sufficient evidence, a laparostomy registry entitled Open Abdomen Route has been implemented in 2015 [29]. An interim analysis shows that in 649 patients with open abdomen management, the indication to open the abdomen was postoperative ACS in 19 patients (2.9%) and pancreatitis in 37 patients (5.7%) [30]. For the near future, until more data are available, treatment of this life threatening syndrome will depend on sound clinical judgment and close cooperation between the critical care, gastro-enterology and surgical disciplines.…”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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Background Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. Results Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. Conclusions The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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“…The concern for NPWT-induced EAF development has later been toned down as a result of increased experience with the technique and succeeding publications stating that the use of NPWT in OA patients, on the contrary, seems to reduce the incidence of EAF compared to non-NPWT-treated patients, especially when combining NPWT with fascial traction (27). In this review, the weighted average for EAF formation was 5.6% (range 0-12%), which is in the lower range of earlier published results for OA treatment, regardless of treatment technique (23,27). Multiple studies have, as shown in this review, evaluated the VAWCM technique without finding proof of problematic EAF formation rates.…”

Section: Discussionmentioning

confidence: 60%

“…Nevertheless, the high weighted average closure rate of 83.5% must be considered a good result, implying that the VAWCM technique is reproducible and relatively simple. A feared complication during OA therapy is the development of an EAF, which has been shown to be a significant predictor of failure of fascial closure and possibly also of mortality in OA patients (10,22) even if an interim analysis from the International Registry of Open Abdomen did not find any EAF impact on mortality (23). A word of caution was raised when NPWT for OA treatment was popularized (24,25).…”

Section: Discussionmentioning

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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“…しかしながら，近年OAMの合併症率については，OAM期間と関連して期間が長くなるほど有意に上昇するという報告 , やsecond–look目的の過度なOAMの実施に警鐘を鳴らす報告もあり，OAMの適応を慎重に検討して，合併症リスクとのバランスをとりながら安全に実施する方法を模索する状況に変遷しつつある。…”

Section: 考　　察unclassified

“…一方で，本研究ではOAMに特徴的な合併症であるentero–atmospheric fistulae（EAF）を認めなかった。Coccoliniらの報告によると，年齢はEAFの発生のリスクファクターではないと結論づけており，またEAFの発生は死亡に影響を与えなかったとしている。…”

Section: 考　　察unclassified

80歳以上の内因性疾患に対するopen abdominal management 22例の報告(Report of postoperative outcomes in non–trauma 22 patients over aged 80 years who underwent open abdominal management)

公一

章浩

浩司

et al. 2020

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　内因性疾患に対するopen abdominal management（OAM）の適応拡大と高齢化に伴い，高齢者に対するOAM施行の機会も多くなっているが，80歳以上の高齢者に対するOAMの有効性や術後合併症についての報告はほとんどなく，その適応についての判断に必要な症例の蓄積もない。今回我々は，当院で施行した80歳以上の内因性疾患患者に対するOAMの術後成績を報告する。2015年8月から2019 年8月の期間に，80歳以上の内因性疾患に対してOAMを施行した症例について診療録を用いて後方視的に調査し，院内死亡，術後合併症を過去の高齢者の緊急開腹手術成績の報告と比較して考察を行った。対象症例22例のうち，院内死亡は4例（18.2%）であった。術後合併症については全合併症の発生を17例（81%）に認め，Clavian–Dindo分類のIII以上の合併症を10例（47.6%）に認めた。年齢層が高いことと死亡についての関連は認められなかったが，OAMの適応疾患により術後合併症の内容に相違が見られた。80歳以上の内因性疾患患者に対するOAMは他の一般的な緊急開腹術後の報告と比較しても院内死亡率は同等であり，術後の高い合併症率には注意が必要であるが，実施を回避すべき明確な理由は認めなかった。

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Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Cited by 62 publications

References 27 publications

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

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

80歳以上の内因性疾患に対するopen abdominal management 22例の報告(Report of postoperative outcomes in non–trauma 22 patients over aged 80 years who underwent open abdominal management)

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