Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients
Autor: | Ari Leppäniemi, Panu Mentula, S K Rasilainen |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male medicine.medical_specialty Heart Diseases Abdominal Wound Closure Techniques Critical Illness Fistula medicine.medical_treatment Respiratory Tract Diseases Peritonitis Young Adult Negative-pressure wound therapy medicine Humans Hernia Aged Retrospective Studies Aged 80 and over business.industry Middle Aged Surgical Mesh medicine.disease Hernia Ventral Surgery body regions Surgical mesh medicine.anatomical_structure Anesthesia Abdomen Female Kidney Diseases Intra-Abdominal Hypertension business Negative-Pressure Wound Therapy |
Zdroj: | British Journal of Surgery. 99:1725-1732 |
ISSN: | 1365-2168 0007-1323 |
Popis: | Background Several temporary abdominal closure techniques have been used in the management of open abdomen. Failure to achieve delayed primary fascial closure results in a large ventral hernia. This retrospective analysis evaluated whether the use of vacuum-assisted closure and mesh-mediated fascial traction (VACM) as temporary abdominal closure improved the delayed primary fascial closure rate compared with non-traction methods. Methods Patients treated with an open abdomen between 2004 and 2010 were analysed. Results Among 50 patients treated with VACM and 54 using non-traction techniques (control group), the delayed primary fascial closure rate was 78 and 44 per cent respectively (P < 0·001); rates among those who survived to abdominal closure were 93 and 59 per cent respectively. Independent predictors of delayed primary fascial closure in multivariable logistic regression analysis were the use of VACM (odds ratio (OR) 4·43, 95 per cent confidence interval 1·64 to 11·99) and diagnosis other than peritonitis, severe acute pancreatitis or ruptured abdominal aortic aneurysm (OR 3·45, 1·07 to 11·04), which represented the main diagnoses. Prophylactic open abdomen was used to inhibit the development of intra-abdominal hypertension more frequently in the VACM group (28 versus 7 per cent; P = 0·008). Twelve per cent of patients in the VACM group developed an enteroatmospheric fistula compared with 19 per cent of control patients. Among survivors, three of 31 treated with VACM and 17 of 36 controls were left with a planned ventral hernia (P = 0·001). Conclusion The indication for open abdomen contributed to the probability of delayed primary fascial closure. VACM resulted in a higher fascial closure rate and lower planned hernia rate than methods that did not provide fascial traction. |
Databáze: | OpenAIRE |
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