Negative Pressure Wound Therapy of Open Abdomen and Definitive Closure Techniques After Decompressive Laparotomy

A Single-Center Observational Prospective Study

Mircea Muresan, MD, PhD; Simona Muresan, MD, PhD; Klara Brinzaniuc, MD, PhD; Daniela Sala, MD, PhD; Radu Neagoe, MD, PhD

Disclosures

Wounds. 2018;30(10):310-316. 

In This Article

Abstract and Introduction

Abstract

Introduction: Open abdomen is a concept that was developed especially in relation to abdominal compartment syndrome (ACS).

Objective: This study presents the evolution and complications related to the management of the open abdomen after decompressive laparotomy, using a standardized method based on negative pressure wound therapy (NPWT).

Materials and Methods: This observational prospective study conducted over a 9-month period included 19 patients who underwent decompressive laparotomies for ACS. The triggering conditions were peritonitis, infected and noninfected acute pancreatitis, ileus, and trauma. Temporary abdominal closure was performed using NPWT and the final closure by primary suture or dual mesh. Intra-abdominal pressure was permanently and indirectly monitored transvesically.

Results: After decompressive laparotomy, the intra-abdominal pressure decreased significantly (P < .001) compared with the value preoperatively (41.4 mm Hg to 15.3 mm Hg). Mortality was 21.2%, with higher rates for acute pancreatitis (odds ratio [OR] = 3.75) and trauma (OR = 1.25) due to the severity of the primary illness. The final closure was performed after 11.7 days, and primary closure was possible in 4 cases.

Conclusions: Decompressive laparotomy significantly reduced intra-abdominal pressure for ACS, improving the prognosis.

Introduction

According to the World Society of the Abdominal Compartment Syndrome (WSACS), the notion of open abdomen means a temporary laparostomy with subsequent closure of the musculoaponeurotic wall and of the skin.[1] The history of open abdomen began in the last century with the first descriptions by McCosh[2] and Ogilvie,[3] and detailed articles were published in the 1980s.[4] After the 1980s, the initial concern of surgeons was strictly linked to the management of the externalized intestines in the peritoneal cavity.[5] The early abdominal closure procedures described were highly complicated, included the preparation of myofascial flaps, and were encumbered by many postoperative complications.[5] Over time, besides temporary abdominal closure (TAC) management, increasingly efficient techniques to reduce the lateral musculoaponeurotic retraction appeared, eventually leading to the description of cases with subsequent myofascial primary closure.[6] The ideal TAC should be easy to perform and allow quick access into the peritoneal cavity so that it may increase the success rate of primary closure and ensure fewer complications.[7]

This paper shows the evolution and complications of open abdomen using a standardized management method, based on negative pressure wound therapy (NPWT), after performing decompressive laparotomies (DLs) as a therapeutic solution to abdominal compartment syndrome (ACS). Decompressive laparotomy is the final stage of ACS treatment and is often not performed. For this reason, the number of patients included in the study is low, but it is high enough to draw proper conclusions, taking into consideration that these are critical patients with severe abdominal disease, organ failure, and peripheral hypoperfusion.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....