Abstract
Introduction
The optimal management of the open abdomen (OA) after liver transplantation (LT) is unclear. The negative pressure wound therapy (NPWT) has been shown to be safe and can increase the chance for early fascial closure in trauma or septic patients. However, little data are available on the specific setting of LT. We aimed to report our experience of OA after LT, marked by the recent use of NPWT.
Methods
All patients with postponed wall closure after LT, from 2002 to 2014, in a single institution were included and retrospectively analyzed. Our management of OA after LT has shifted from skin-only closure (SOC) followed by abdominal wall reconstruction at a distance to the use of NPWT with early fascial closure.
Results
Of the 1559 LTs performed during the study period, immediate abdominal wall closure at the end of transplantation could not be achieved in 46 (2.9%) patients. Of them, SOC was performed in 22 (47.8%) patients, whereas vacuum-assisted closure (VAC) therapy was used in 24 (52.1%) patients. The comprehensive complication indexes (CCI) were similar [CCI: 66 (0–100) in the SOC group vs. 56 (0–100) in the VAC group; p = 0.55]. No evisceration or fistula occurred in both groups. One (4.2%) postoperative bleeding case was reported in the VAC group. Early fascial closure was achieved within a median of 5.5 days (1–12) for the 24 patients (100%) of the VAC group. In four of them, a biological mesh was necessary. Only nine patients (52.9%) of the survivors in the SOC group underwent abdominal reconstruction.
Conclusion
The NPWT in patients with OA after LT enables early fascial closure with limited morbidity provided a specific attention is given to the risk of bleeding. These results support the use of NPWT as the first option in OA patients after LT.
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References
Moore EE, Burch JM, Franciose RJ et al (1998) Staged physiologic restoration and damage control surgery. World J Surg 22:1184–1191. doi:10.1007/s002689900542
Tremblay LN, Feliciano DV, Schmidt J et al (2001) Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg 182:670–675. doi:10.1016/S0002-9610(01)00805-4
Leppäniemi A, Tukiainen E (2012) Planned hernia repair and late abdominal wall reconstruction. World J Surg 36:511–515. doi:10.1007/s00268-011-1177-5
Sherck J, Seiver A, Shatney C et al (1998) Covering the “open abdomen”: a better technique. Am Surg 64:854–857
Yeh KA, Saltz R, Howdieshell TR (1996) Abdominal wall reconstruction after temporary abdominal wall closure in trauma patients. South Med J 89:497–502
Ghimenton F, Thomson SR, Muckart DJJ, Burrows R (2000) Abdominal content containment: practicalities and outcome. Br J Surg 87:106–109. doi:10.1046/j.1365-2168.2000.01337.x
Hatch QM, Osterhout LM, Ashraf A et al (2011) Current use of damage-control laparotomy, closure rates, and predictors of early fascial closure at the first take-back. J Trauma 70:1429–1436. doi:10.1097/TA.0b013e31821b245a
Barker DE, Green JM, Maxwell RA et al (2007) Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg 204:784–792. doi:10.1016/j.jamcollsurg.2006.12.039
Brustia R, Perdigao F, Sepulveda A et al (2015) Negative wound therapy to manage large-for-size liver graft mismatch. Clin Res Hepatol Gastroenterol. doi:10.1016/j.clinre.2015.02.009
Assirati G, Serra V, Tarantino G et al (2016) Vacuum-assisted closure therapy in patients undergoing liver transplantation with necessity to maintain open abdomen. Transplant Proc 48:383–385. doi:10.1016/j.transproceed.2015.12.037
Levesque E, Duclos J, Ciacio O et al (2013) Influence of larger graft weight to recipient weight on the post-liver transplantation course. Clin Transplant 27:239–247. doi:10.1111/ctr.12059
Jernigan T, Fabian T, Croce M et al (2003) Staged management of giant abdominal wall defects. Ann Surg 238:349–357. doi:10.1097/01.sla.0000086544.42647.84
Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7. doi:10.1097/SLA.0b013e318296c732
Miller PR, Thompson JT, Faler BJ et al (2002) Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma 53:843–849. doi:10.1097/01.TA.0000027879.14969.C9
Open Abdomen Advisory Panel, Campbell A, Chang M et al (2009) Management of the open abdomen: from initial operation to definitive closure. Am Surg 75:S1–22
Cheatham ML, Demetriades D, Fabian TC et al (2013) Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg 37:2018–2030. doi:10.1007/s00268-013-2080-z
Vos RJ, Yilmaz A, Sonker U, Kloppenburg GTL (2013) Acute mediastinal bleeding during vacuum-assisted closure. Int Wound J 10:348–350. doi:10.1111/j.1742-481X.2012.00989.x
Sjögren J, Gustafsson R, Nilsson J et al (2011) Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-day mortality in 176 patients with deep sternal wound infection. Interact CardioVasc Thorac Surg 12:117–120. doi:10.1510/icvts.2010.252668
van Wingerden JJ, Segers P, Jekel L (2011) Major bleeding during negative pressure wound/VAC®—therapy for postsurgical deep sternal wound infection—a critical appraisal. J Cardiothorac Surg 6:121. doi:10.1186/1749-8090-6-121
Li Z, Yu A (2014) Complications of negative pressure wound therapy: a mini review. Wound repair Regen 22:457–461. doi:10.1111/wrr.12190
Miller PR, Meredith JW, Johnson JC, Chang MC (2004) Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg 239:608–616. doi:10.1097/01.sla.0000124291.09032.bf
Cothren CC, Moore EE, Johnson JL et al (2006) One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg 192:238–242. doi:10.1016/j.amjsurg.2006.04.010
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Hobeika, C., Allard, MA., Bucur, PO. et al. Management of the Open Abdomen after Liver Transplantation. World J Surg 41, 3199–3204 (2017). https://doi.org/10.1007/s00268-017-4125-1
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DOI: https://doi.org/10.1007/s00268-017-4125-1