Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

Abstract

Introduction Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment. Methods A retrospective review of all patients that underwent midline laparotomy between January 2008 and December 2012 was performed. Both factors predicting open abdominal treatment and possibility to close the fascia afterwards were identified and analyzed by univariate and multivariate analyses. Results 775 laparotomies in 525 patients (60% male) were included. 109 patients (21%) had an open abdomen with a mortality rate of 27%. Male gender and acidosis were associated with open abdominal treatment. In 54%, the open abdomen could be closed by delayed fascial closure. The number of laparotomies both before and during temporary abdominal treatment was associated with failure of closure. Conclusion In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures.Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry

“…Intra-abdominal contamination and the number of surgical procedures before OAT were found to be the only factors that were negatively correlated with DFC. This result confirms the previous observation reported by Karhof et al [ 4 ].…”

“…The composition of the patient population and the indications for OA management reflect those commonly found in similar cohort of patients in Europe: the most frequently reported indication for OA was peritonitis, followed by ACS, and burst abdomen. Trauma accounted for only 9% [ 4 , 10 , 11 , 17 , 36 , 37 ]. In this study, an in-hospital mortality rate of 19% was in line with the literature on OAT, where it varies between 10 and 45% [ 14 , 23 , 36 – 41 ].…”

“…Open abdomen treatment (OAT) involves the deliberate decision not to close the fascia at the end of laparotomy [1,2]. This surgical strategy is used in the management of critically ill patients with serious intra-abdominal conditions [3][4][5], e.g. severe secondary peritonitis, abdominal trauma, or abdominal compartment syndrome.…”

“…abbreviated laparotomy strategy, to temporarily close the abdomen in a sterile environment and tension-free environment, and to facilitate second-look operations. Morbidity and mortality rates can thus be reduced in critically ill patients whose systemic compensatory mechanisms are depleted and whose physiological reserves are nearly exhausted [3][4][5][6]8].…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

“…The vast majority of the world literature concerning the OA and abdominal wall management is derived from trauma patients. As such, not all conclusions are applicable to the septic abdomen, as trauma patients more frequently achieve definitive abdominal closure within 48 h of creation of the OA compared with patients who have an OA for peritonitis [ 545 ].…”