Vacuum-Assisted Abdominal Closure Is Safe and Effective: A Cohort Study in 74 Consecutive Patients

Abstract

Background Vacuum-assisted closure (VAC) has, in many instances, become the treatment of choice in patients with abdominal catastrophes. This study describes the use and outcome of ABThera KCI® VAC in the Region Southern Denmark covering a population of approximately 1.202 mill inhabitants. Method A prospective multicenter study including all patients treated with VAC during an eleven-month period. Results A total of 74 consecutive patients were included. Median age was 64.4 (9–89) years, 64% were men, and median body mass index was 25 (17–42). Duration of VAC treatment was median 4.5 (0–39) days with median 1 (0–16) dressing changes. Seventy per cent of the patients attended the intensive care unit. The 90-day mortality was 15%. A secondary closure of the fascia was obtained in 84% of the surviving patients. Only one patient developed an enteroatmospheric fistula. Patients with secondary closure were less likely to develop large hernias and had better self-evaluated physical health score (p < 0,05). No difference in mental health was found. Conclusion The abdominal VAC treatment in patients with abdominal catastrophes is safe and with a relative low complication rate. Whether it might be superior to conventional treatment with primary closure when possible has yet to be proven in a randomized study.

Vacuum-Assisted Abdominal Closure in Surgical Emergency: A Single Institution Experience Treating a Cohort with a Prevalence of Faecal Peritonitis

“…*SOFA score: 7 vs. 3, p = 0.037, 7 vs. 1, p < 0.001, 7 vs. PRE, p < 0.001, 3 vs. 1, p = 0.007, 3 vs. PRE, p < 0.001, 1 vs. PRE, p = 0.111; ** CRP: 7 vs. 3, p < 0.001, 7 vs. 1, p < 0.001, 7 vs. PRE, p < 0.001, 3 vs. 1, p < 0.001, 3 vs. PRE, p < 0.001, 1 vs. PRE, p = 1.0; ***PCT: 7 vs. 3, p < 0.001, 7 vs. 1, p < 0.001, 7 vs. PRE, p < 0.001, 3 vs. 1, p < 0. (Kafka-Ritsch et al, 2012;Bleszynski et al, 2016;Tartaglia et al, 2019) and some differ (Rezende-Neto et al, 2016;Jensen et al, 2017;Sartelli et al, 2019) from the current study. The important criteria for definitive closure included visual signs of intestinal viability, provision of full source control, no need for further surgical re-exploration, and no concerns for ACS (Rezende-Neto et al, 2016;Coccolini et al, 2018b;Sartelli et al, 2019).…”

“…It was confirmed that the predominant source is from the lower GIT segments and that the microflora is associated with late colonisation, when a longer duration of the OA is needed (Rasilainen et al, 2015). The different bacteriologic pattern reported earlier may be explained by the large difference in patient cohorts and the traditional consumption of meat and animal fats (Carlson et al, 2013;Sartelli et al, 2014;Rasilainen et al, 2015;Jensen et al, 2017;Sartelli et al, 2017a). Several laboratory tests and scores are approved as effective criteria for the assessment of the clinical course of sepsis, including the biochemical markers of inflammation -CRP, PCT, the SOFA score and others (Schmit and Vincent, 2008;Cho and Choi, 2014;Sartelli et al, 2017b;Schmidt de Oliveira-Netto et al, 2019).…”

“…The majority of studies focus on the methods of complete abdominal closure and include the whole patient spectrum in different proportions. The time of complete abdominal closure differs significantly between trauma patients with damage control and patients with advanced peritonitis (Carlson et al, 2013;Godat et al, 2013;Atema et al, 2015;Jensen et al, 2017;Hu et al, 2018). The OA strategy, or postponing complete abdominal closure, is recommended in patients who are at risk of postoperative IAH, if repeated abdominal exploration is necessary due to CIAI and advanced peritonitis, or in critical patients with severely deranged physiologic response according to the damage control strategy (Coccolini et al, 2018b).…”

“…However, recommendations for the appropriate fascial closure time are still lacking, and in the late stage of the disease, surgeons are mostly fighting with complications that are associated with NPWT application (Morykwas et al, 1997;Atema et al, 2015;Bleszynski et al, 2016;Coccolini et al, 2017;Tolonen et al, 2017;Coccolini, Ceresoli, et al, 2018). Clearance of the purulent contents and fibrin deposits, signs of well-perfused functioning bowels, regression of sepsis, normalisation of CRP and visual confirmation of complete source control during the repeated laparotomy may indicate that definitive abdominal closure is possible even in cases when abdominal bacte-rial cultures are positive (Plaudis et al, 2012;Rasilainen et al, 2015;Jensen et al, 2017;Loftus et al, 2017;Sartelli et al, 2017a;Tolonen et al, 2017). The median ICU and hospital stay varies greatly and depends on the medical condition and reason why the OA strategy has been chosen.…”

Invited Commentary: The Efficacy of VAMMFT Compared to “Bogota Bag” in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma

“…VAMFT is a newer temporary abdominal closure technique that was introduced in the early 2000s, on the other hand, involves the use of a mesh material that is placed over the open abdomen and secured with suture. A vacuum device is then attached to the mesh, which creates negative pressure that helps to keep the abdominal contents in place and decrease the risk of herniation [4]. The mesh is placed over the area of interest and connected to the pump, which creates a vacuum that draws the mesh and the underlying tissue towards it.…”