VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen

Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222–4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen.

[1]  Ning Li,et al.  Fluid volume overload negatively influences delayed primary facial closure in open abdomen management. , 2014, The Journal of surgical research.

[2]  T. Wolvos.  Negative pressure wound therapy with instillation: the current state of the art. , 2014, Surgical technology international.

[3]  C. Trial,et al.  Negative pressure wound therapy with saline instillation: 131 patient case series , 2013, International wound journal.

[4]  D. Back,et al.  Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show? , 2013, International wound journal.

[5]  A. Leppäniemi,et al.  Vacuum and mesh‐mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients , 2012, The British journal of surgery.

[6]  B. Collier,et al.  Nutrition and the open abdomen. , 2012, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[7]  S. Ogston,et al.  The open abdomen and temporary abdominal closure systems – historical evolution and systematic review , 2012, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[8]  A. Wanhainen,et al.  Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh‐mediated fascial traction , 2011, The British journal of surgery.

[9]  F. Penninckx,et al.  Can vacuum-assisted closure and instillation therapy (VAC-Instill® therapy) play a role in the treatment of the infected open abdomen? , 2011, Techniques in Coloproctology.

[10]  K. Slim,et al.  Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial. , 2010, Archives of surgery.

[11]  G. Nieman,et al.  Peritoneal Negative Pressure Therapy Prevents Multiple Organ Injury in a Chronic Porcine Sepsis and Ischemia/Reperfusion Model , 2010, Shock.

[12]  R. Dutton,et al.  Changing paradigms in surgical resuscitation , 2010, Critical care medicine.

[13]  J. Como,et al.  The management of the open abdomen in trauma and emergency general surgery: part 1-damage control. , 2010, The Journal of trauma.

[14]  K. Mukherjee,et al.  Early Fascial Closure of the Damage Control Abdomen in Children , 2010, The American surgeon.

[15]  E. Irwin,et al.  Early enteral nutrition can be successfully implemented in trauma patients with an "open abdomen". , 2010, American journal of surgery.

[16]  R. Reed,et al.  Management of the open abdomen: from initial operation to definitive closure. , 2009, The American surgeon.

[17]  A. Maw,et al.  Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. , 2009, Annals of the Royal College of Surgeons of England.

[18]  J. Solomkin,et al.  Intra-abdominal sepsis: newer interventional and antimicrobial therapies. , 2009, Infectious disease clinics of North America.

[19]  I. Shaikh,et al.  Topical negative pressure in managing severe peritonitis: a positive contribution? , 2009, World journal of gastroenterology.

[20]  D. McAuley,et al.  Preliminary Results of a Prospective Randomized Trial of Restrictive Versus Standard Fluid Regime in Elective Open Abdominal Aortic Aneurysm Repair , 2009, Annals of surgery.

[21]  M. Björck,et al.  Classification—Important Step to Improve Management of Patients with an Open Abdomen , 2009, World Journal of Surgery.

[22]  B. Cotton,et al.  Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. , 2009, The Journal of trauma.

[23]  J. Wind,et al.  UvA-DARE ( Digital Academic Repository ) Temporary Closure of the Open Abdomen : A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen , 2008 .

[24]  Subhas C. Gupta,et al.  Negative pressure wound therapy with instillation: a pilot study describing a new method for treating infected wounds , 2008, International wound journal.

[25]  M. Björck,et al.  Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction—A Novel Technique for Late Closure of the Open Abdomen , 2007, World Journal of Surgery.

[26]  Oscar D. Guillamondegui,et al.  Feeding the open abdomen. , 2007, JPEN. Journal of parenteral and enteral nutrition.

[27]  E. Luque-de-León,et al.  Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. , 2007, Surgical infections.

[28]  F. Van Rooy,et al.  Systemic Peritoneal Cavity Lavage: a New Strategy for Treatment of the Open Septic Abdomen , 2007, Acta chirurgica Belgica.

[29]  K. Hillman,et al.  Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations , 2006, Intensive Care Medicine.

[30]  R. Ivatury,et al.  Management of open abdomen. , 2007, Acta clinica Belgica.

[31]  K. Hillman,et al.  Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions , 2006, Intensive Care Medicine.

[32]  E. Moore,et al.  Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure. , 2004, American journal of surgery.

[33]  B. Boulanger,et al.  The Open Peritoneal Cavity: Etiology Correlates with the Likelihood of Fascial Closure , 2004, The American surgeon.

[34]  T. Fabian,et al.  Staged Management of Giant Abdominal Wall Defects: Acute and Long-Term Results , 2003, Annals of surgery.

[35]  James W. Jones,et al.  Staged primary closure of the open abdomen. , 2002, The Journal of trauma.

[36]  Louis C. Argenta,et al.  Vacuum‐Assisted Closure: A New Method for Wound Control and Treatment: Clinical Experience , 1997, Annals of plastic surgery.

[37]  P. Barie,et al.  Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. , 1993, Archives of surgery.