Open abdomen management by vacuum with and without dynamic abdominal wall traction

Abstract

Background: the Open Abdomen (OA) has been defined as the separation of the cutaneous, muscular and aponeurotic layers after a laparotomy. It requires a Temporary Abdominal Closure (TAC) which main objectives are abdominal containment, viscera protection and to avoid aponeurotic retraction.
Objective: to present our experience in the treatment of OA through vacuum with and without mesh traction, and to analyze the results in terms of delayed abdominal wall closure, incidence of enteroatmospheric fistulas (FEa) and mortality.
Material and methods: between March 2008 and September 2016, patients with OA treated by vacuum were retrospectively analyzed. From 2012 the technique was modified adding a prosthetic mesh. The overall characteristics of the population were recorded and according to the applied TAC method (V: vacuum and VM: vacuum + mesh). The following variables were controlled as risk factors (RF)for failure of delayed wall closure, such as organic dysfunction, peritonitis, previous surgeries, ostomies and the reason for OA. The specific objectives were to analyze the relationship between RF and delayed closure, and to determine the probability of primary closure, incidence of fistulas and mortality, overall and by groups.
Results: twenty seven patients were included in the present study. The average age was 52 years old. The average length of treatment was 26 days; 32 days being for group V and 20 days for VM (p = 0.016). There was an increase in the delayed closure in the absence of RF, without enough evidence given the low power of the tests. A clinically relevant difference