The Abdominal Reapproximation Anchor Device

Okullo, Alfin; Siriwardhane, Mehan; Pang, Tony; Sinclair, Jane-Louise B; Lam, Vincent; Richardson, A. J.; Pleass, Henry; Johnston, Emma

doi:10.1177/1553350616671640

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…There are some potential disadvantages to the ABRA device. It is not immediately available in most hospitals and its use must be planned for. The device is costly – however, the reduction in visits to the operating room and potential for mitigating future hernia may quickly offset this cost. The ABRA can create pressure areas under the buttons. These appear to heal with adequate wound care without ongoing issues 9,17 . Careful attention to skin care is required by the surgical team as described by our paper. …”

Section: Discussionmentioning

confidence: 81%

“…The advantages of the ABRA device have been described by several papers including ours, reporting PFC rates in patients managed with the ABRA ranging between 61–100%. Okullo et al 17 . reported 75% PFC over 11 days in four patients using the device.…”

Section: Discussionmentioning

confidence: 97%

“…16 The advantages of the ABRA device have been described by several papers including ours, reporting PFC rates in patients managed with the ABRA ranging between 61-100%. Okullo et al 17 reported 75% PFC over 11 days in four patients using the device. Verdam et al 7 reported 88% of patients achieving PFC in 15 days with four of 14 patients developing a midline hernia in the long term.…”

Section: Discussionmentioning

confidence: 98%

“…These appear to heal with adequate wound care without ongoing issues. 9,17 Careful attention to skin care is required by the surgical team as described by our paper.…”

Section: Discussionmentioning

confidence: 99%

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The Abdominal Re‐Approximation Anchor device (ABRA®) has the potential to be useful in both emergency and elective dynamic temporary fascial closure

Chen

McLaren

Slater

2020

ANZ Journal of Surgery

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Background: The management of an open abdomen (OA) remains an evolving field because of its relative rarity. Many techniques to achieve temporary abdominal closure exist, but often require multiple returns to the operating theatre and usually do not address the issue of lateral fascial retraction and do not achieve primary fascial closure (PFC). The ensuing incisional hernias result in a significant surgical challenge affecting both the physical and mental health of the patient. We describe our experience with the Abdominal Reapproximation Anchor (ABRA) device, which addresses some of these issues. Methods: The records of patients with an OA managed by a single surgeon using the ABRA device at Princess Alexandra Hospital, Queensland, Australia, between December 2014 and April 2020 were analysed retrospectively. Results: Six patients with OA were managed with the ABRA. All patients required an OA for the ramification of intraabdominal sepsis. Three patients were managed with the ABRA device electively and three in the acute setting. 100% of patients achieved PFC. Average follow-up was 40 months with three developing incisional hernias that were subsequently repaired. Conclusion: The OA in critically ill surgical patients remains one of the most challenging problems in general surgery. The ABRA device is simple to use and has shown positive outcomes in both the acute and elective setting. Our use has resulted in 100% PFC, which demonstrates that the ABRA device is an important tool for the general surgeon in managing these complex cases.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

“…These appear to heal with adequate wound care without ongoing issues. 9,17 Careful attention to skin care is required by the surgical team as described by our paper.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Abdominal Re‐Approximation Anchor device (ABRA®) has the potential to be useful in both emergency and elective dynamic temporary fascial closure

Chen

McLaren

Slater

2020

ANZ Journal of Surgery

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“…However, early PFC of OA still remains a challenge. In the last decade, several techniques for temporary abdominal closure systems (TAC) of OA have been implemented including Bogotá bag, Wittmann Patch®, skin closure only, dynamic fascial traction devices, and negative pressure wound therapy (NPWT) [10][11][12][13][14][15][16]. PFC rates of various TAC techniques are heterogeneous and have been reported with 69-92% [4,13,17,18].…”

Section: Introductionmentioning

confidence: 99%

Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen

Fung

Ashmawy

Krieglstein³

et al. 2022

Langenbecks Arch Surg

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Purpose One of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction. Methods Twenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT). Results The mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia. Conclusion Vertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.

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EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

López-Cano

García-Alamino

Antoniou

et al. 2018

Hernia

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When considering the OA, dynamic closure techniques should be prioritized over the use of static closure techniques (strong recommendation). However, for techniques including suture closure, mesh reinforcement, component separation techniques and skin grafting, only clinical expertise guidance was provided. Considering the BA, a clinical expertise guidance statement was advised for dynamic closure techniques. Additionally, a clinical expertise guidance statement concerning suture closure and a good practice statement concerning mesh reinforcement during fascial closure were proposed. The role of advanced techniques such as component separation or relaxing incisions is questioned. In addition, the role of the abdominal girdle seems limited to very selected patients.

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The Abdominal Reapproximation Anchor Device

Abstract: The ABRA is a unique emerging alternative to aid in achieving fascial closure in patients managed with open abdomens. Our case series demonstrates that it can be used effectively in selected patients. Studies are needed to compare its efficacy with more traditional methods.

Cited by 7 publications

References 5 publications

The Abdominal Re‐Approximation Anchor device (ABRA®) has the potential to be useful in both emergency and elective dynamic temporary fascial closure

The Abdominal Re‐Approximation Anchor device (ABRA®) has the potential to be useful in both emergency and elective dynamic temporary fascial closure

Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen

EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

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