Abstract
Background
Several challenging clinical situations in patients with peritonitis can result in an open abdomen (OA) and subsequent temporary abdominal closure (TAC). Indications and treatment choices differ among surgeons. The risk of fistula development and the possibility to achieve delayed fascial closure differ between techniques. The aim of this study was to review the literature on the OA and TAC in peritonitis patients, to analyze indications and to assess delayed fascial closure, enteroatmospheric fistula and mortality rate, overall and per TAC technique.
Methods
Electronic databases were searched for studies describing the OA in patients of whom 50 % or more had peritonitis of a non-traumatic origin.
Results
The search identified 74 studies describing 78 patient series, comprising 4,358 patients of which 3,461 (79 %) had peritonitis. The overall quality of the included studies was low and the indications for open abdominal management differed considerably. Negative pressure wound therapy (NPWT) was the most frequent described TAC technique (38 of 78 series). The highest weighted fascial closure rate was found in series describing NPWT with continuous mesh or suture mediated fascial traction (6 series, 463 patients: 73.1 %, 95 % confidence interval 63.3–81.0 %) and dynamic retention sutures (5 series, 77 patients: 73.6 %, 51.1–88.1 %). Weighted rates of fistula varied from 5.7 % after NPWT with fascial traction (2.2–14.1 %), 14.6 % (12.1–17.6 %) for NPWT only, and 17.2 % after mesh inlay (17.2–29.5 %).
Conclusion
Although the best results in terms of achieving delayed fascial closure and risk of enteroatmospheric fistula were shown for NPWT with continuous fascial traction, the overall quality of the available evidence was poor, and uniform recommendations cannot be made.
Similar content being viewed by others
References
Tsuei BJ, Skinner JC, Bernard AC, Kearney PA, Boulanger BR (2004) The open peritoneal cavity: etiology correlates with the likelihood of fascial closure. Am Surg 70(7):652–656
Quyn AJ, Johnston C, Hall D et al (2012) The open abdomen and temporary abdominal closure systems–historical evolution and systematic review. Colorectal Dis 14(8):e429–e438
van Boele HP, Wind J, Dijkgraaf MG, Busch OR, Goslings JC (2009) Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg 33(2):199–207. doi:10.1007/s00268-008-9867-3
Trevelyan SL, Carlson GL (2009) Is TNP in the open abdomen safe and effective? J Wound Care 18(1):24–25
Rao M, Burke D, Finan PJ, Sagar PM (2007) The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis 9(3):266–268
Fischer JE (2008) A cautionary note: the use of vacuum-assisted closure systems in the treatment of gastrointestinal cutaneous fistula may be associated with higher mortality from subsequent fistula development. Am J Surg 196(1):1–2
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12
Wells G, Shea B, O’Connell D et al. (2009) The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohrica/programs/clinical_epidemiology/oxford.asp. Accessed 6 July 2012
Carlson GL, Patrick H, Amin AI et al (2013) Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg 257:1154–1159
Rasilainen SK, Mentula PJ, Leppaniemi AK (2012) Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg 99(12):1725–1732
Pliakos I, Papavramidis TS, Michalopoulos N et al (2012) The value of vacuum-assisted closure in septic patients treated with laparostomy. Am Surg 78(9):957–961
Martinez-Ordaz JL, Cruz-Olivo PA, Chacon-Moya E et al (2004) Management of the abdominal wall in sepsis. Comparison of two techniques. Rev Gastroenterol Mex 69(2):88–93
Garcia Iniguez JA, Orozco CF, Mucino Hernandez MI et al (2004) Complications of the management of secondary peritonitis with contained-open abdomen. Comparison of the Bogota’s bag vs polypropylene mesh. Rev Gastroenterol Mex 69(3):147–155
Goussous N, Jenkins DH, Zielinski MD (2013) Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage. Injury. doi:10.1016/j.injury.2013.01.039
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(5):784–792
Oetting P, Rau B, Schlag PM (2006) Abdominal vacuum device with open abdomen. Chirurg 77(7):586, 588–6, 593
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(6):670–675
Kritayakirana K, Maggio M, Brundage S et al (2010) Outcomes and complications of open abdomen technique for managing non-trauma patients. J Emerg Trauma Shock 3(2):118–122
Prichayudh S, Sriussadaporn S, Samorn P et al (2011) Management of open abdomen with an absorbable mesh closure. Surg Today 41(1):72–78
Schein M (1991) Planned reoperations and open management in critical intra-abdominal infections: prospective experience in 52 cases. World J Surg 15(4):537–545. doi:10.1007/BF01675658
Robledo FA, Luque-de-Leon E, Suarez R et al (2007) Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect (Larchmt) 8(1):63–72
Gentile AT, Feliciano PD, Mullins RJ et al (1998) The utility of polyglycolic acid mesh for abdominal access in patients with necrotizing pancreatitis. J Am Coll Surg 186(3):313–318
Adkins AL, Robbins J, Villalba M, Bendick P, Shanley CJ (2004) Open abdomen management of intra-abdominal sepsis. Am Surg 70(2):137–140
Amin AI, Shaikh IA (2009) Topical negative pressure in managing severe peritonitis: a positive contribution? World J Gastroenterol 15(27):3394–3397
Anderson ED, Mandelbaum DM, Ellison EC, Carey LC, Cooperman M (1983) Open packing of the peritoneal cavity in generalized bacterial peritonitis. Am J Surg 145(1):131–135
Bailey CM, Thompson-Fawcett MW, Kettlewell MG, Garrard C, Mortensen NJ (2000) Laparostomy for severe intra-abdominal infection complicating colorectal disease. Dis Colon Rectum 43(1):25–30
Bosscha K, Hulstaert PF, Visser MR, van Vroonhoven TJ, van der Werken C (2000) Open management of the abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg 166(1):44–49
Cipolla J, Stawicki SP, Hoff WS et al (2005) A proposed algorithm for managing the open abdomen. Am Surg 71(3):202–207
Fortelny RH, Hofmann A, Gruber-Blum S, Petter-Puchner AH, Glaser KS (2013) Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture. Surg Endosc. doi:10.1007/s00464-013-3251-6
Gonullu D, Koksoy FN, Demiray O et al (2009) Laparostomy in patients with severe secondary peritonitis. Ulus Travma Acil Cerrahi Derg 15(1):52–57
Hakkiluoto A, Hannukainen J (1992) Open management with mesh and zipper of patients with intra-abdominal abscesses or diffuse peritonitis. Eur J Surg 158(8):403–405
Hubens G, Lafaire C, De PM et al (1994) Staged peritoneal lavages with the aid of a Zipper system in the treatment of diffuse peritonitis. Acta Chir Belg 94(3):176–179
Kafka-Ritsch R, Birkfellner F, Perathoner A et al (2012) Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV. J Gastrointest Surg 16(10):1915–1922
Kleif J, Fabricius R, Bertelsen CA, Bruun J, Gogenur I (2012) Promising results after vacuum-assisted wound closure and mesh-mediated fascial traction. Dan Med J 59(9):A4495
Koniaris LG, Hendrickson RJ, Drugas G, Abt P, Schoeniger LO (2001) Dynamic retention: a technique for closure of the complex abdomen in critically ill patients. Arch Surg 136(12):1359–1362
Lopez-Quintero L, Evaristo-Mendez G, Fuentes-Flores F, Ventura-Gonzalez F, Sepulveda-Castro R (2010) Treatment of open abdomen in patients with abdominal sepsis using the vacuum pack system. Cir Cir 78(4):322–326
Padalino P, Dionigi G, Minoja G et al (2010) Fascia-to-fascia closure with abdominal topical negative pressure for severe abdominal infections: preliminary results in a department of general surgery and intensive care unit. Surg Infect (Larchmt) 11(6):523–528
Pliakos I, Michalopoulos N, Papavramidis TS et al (2013) The effect of vacuum-assisted closure in bacterial clearance of the infected abdomen. Surg Infect (Larchmt). doi:10.1089/sur.2012.156
Reimer MW, Yelle JD, Reitsma B et al (2008) Management of open abdominal wounds with a dynamic fascial closure system. Can J Surg 51(3):209–214
Schmelzle M, Alldinger I, Matthaei H et al (2010) Long-term vacuum-assisted closure in open abdomen due to secondary peritonitis: a retrospective evaluation of a selected group of patients. Dig Surg 27(4):272–278
Wondberg D, Larusson HJ, Metzger U, Platz A, Zingg U (2008) Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg 32(12):2724–2729. doi:10.1007/s00268-008-9762-y
Dietz UA, Wichelmann C, Wunder C et al (2012) Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia. Hernia 16(4):451–460
Hedderich GS, Wexler MJ, McLean AP, Meakins JL (1986) The septic abdomen: open management with Marlex mesh with a zipper. Surgery 99(4):399–408
Ivatury RR, Nallathambi M, Rao PM, Rohman M, Stahl WM (1989) Open management of the septic abdomen: therapeutic and prognostic considerations based on APACHE II. Crit Care Med 17(6):511–517
Kirshtein B, Roy-Shapira A, Lantsberg L, Mizrahi S (2007) Use of the “Bogota bag” for temporary abdominal closure in patients with secondary peritonitis. Am Surg 73(3):249–252
Losanoff J, Kjossev K (1997) Palisade dorsoventral lavage for neglected peritonitis. Am J Surg 173(2):134–135
Losanoff JE, Kjossev KT (1997) Mesh-foil laparostomy. J Am Coll Surg 185(1):89–92
Manterola C, Moraga J, Urrutia S (2011) Contained laparostomy with a Bogota bag. Results of case series. Cir Esp 89(6):379–385
Zingales F, Moschino P, Carniato S et al (2001) Laparostomy in the treatment of severe peritonitis: a review of 60 cases. Chir Ital 53(6):821–826
Tons C, Schachtrupp A, Rau M, Mumme T, Schumpelick V (2000) Abdominal compartment syndrome: prevention and treatment. Chirurg 71(8):918–926
Haddock C, Konkin DE, Blair NP (2013) Management of the open abdomen with the abdominal reapproximation anchor dynamic fascial closure system. Am J Surg 205(5):528–533
Khan A, Hsee L, Mathur S, Civil I (2013) Damage-control laparotomy in nontrauma patients: review of indications and outcomes. J Trauma Acute Care Surg 75(3):365–368
Hollender LF, Bur F, Schwenck D, Pigache P (1983) The “left-open abdomen”. Technic, indication and results. Chirurg 54(5):316–319
Brock WB, Barker DE, Burns RP (1995) Temporary closure of open abdominal wounds: the vacuum pack. Am Surg 61(1):30–35
Caro A, Olona C, Jimenez A et al (2011) Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases. Int Wound J 8(3):274–279
Fieger AJ, Schwatlo F, Mundel DF et al (2011) Abdominal vacuum therapy for the open abdomen: a retrospective analysis of 82 consecutive patients. Zentralbl Chir 136(1):56–60
Horwood J, Akbar F, Maw A (2009) Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Ann R Coll Surg Engl 91(8):681–687
Ozguc H, Paksoy E, Ozturk E (2008) Temporary abdominal closure with the vacuum pack technique: a 5-year experience. Acta Chir Belg 108(4):414–419
Perez D, Wildi S, Demartines N et al (2007) Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 205(4):586–592
Perez DL, Pardellas RH, Caceres AN et al (2012) Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients. Cir Esp 90(8):506–512
Plaudis H, Rudzats A, Melberga L et al (2012) Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis: prospective study and critical review of literature. Ann Intensive Care 2(Suppl 1):S23
Shaikh IA, Ballard-Wilson A, Yalamarthi S, Amin AI (2010) Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae. Colorectal Dis 12(9):931–934
Smith LA, Barker DE, Chase CW et al (1997) Vacuum pack technique of temporary abdominal closure: a four-year experience. Am Surg 63(12):1102–1107
Wilde JM, Loudon MA (2007) Modified Opsite sandwich for temporary abdominal closure: a non-traumatic experience. Ann R Coll Surg Engl 89(1):57–61
Zielinski MD, Goussous N, Schiller HJ, Jenkins D (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17(1):101–107
Bertelsen CA, Fabricius R, Kleif J, Kristensen B, Gogenur I (2013) Outcome of negative-pressure wound therapy for open abdomen treatment after nontraumatic lower gastrointestinal surgery: analysis of factors affecting delayed fascial closure in 101 patients. World J Surg. doi:10.1007/s00268-013-2360-7
Richter S, Dold S, Doberauer JP, Mai P, Schuld J (2013) Negative pressure wound therapy for the treatment of the open abdomen and incidence of enteral fistulas: a retrospective bicentre analysis. Gastroenterol Res Pract 2013:730829
Kafka-Ritsch R, Zitt M, Schorn N et al (2012) Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate. World J Surg 36(8):1765–1771. doi:10.1007/s00268-012-1586-0
Acosta S, Bjarnason T, Petersson U et al (2011) Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg 98(5):735–743
Huang Q, Zhao R, Yue C et al (2013) Fluid volume overload negatively influences delayed primary facial closure in open abdomen management. J Surg Res. doi:10.1016/j.jss.2013.09.032
Schachtrupp A, Hoer J, Tons C et al (2002) Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia 6(3):102–107
Sokmen S, Atila K, Bora S et al (2002) Evaluation of prosthetic mesh closure in semiopen-abdomen patients. Hernia 6(3):124–129
Doyon A, Devroede G, Viens D et al (2001) A simple, inexpensive, life-saving way to perform iterative laparotomy in patients with severe intra-abdominal sepsis. Colorectal Dis 3(2):115–121
Ercan F, Korkmaz A, Aras N (1993) The zipper-mesh method for treating delayed generalized peritonitis. Surg Today 23(3):205–214
Salman AE, Yetisir F, Aksoy M et al (2012) Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen. Hernia. doi:10.1007/s10029-012-1008-0
Verdam FJ, Dolmans DE, Loos MJ et al (2011) Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg 35(10):2348–2355. doi:10.1007/s00268-011-1210-8
Wittmann DH (2000) Staged adbominal repair: development and current practice of an advanced operative technique for diffuse suppurative peritonitis. Acta Chir Austriaca 32:171–178
Wittmann DH, Aprahamian C, Bergstein JM (1990) Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg 14(2):218–226. doi:10.1007/BF01664876
Jansen JO, Loudon MA (2007) Damage control surgery in a non-trauma setting. Br J Surg 94(7):789–790
van Ruler O, Mahler CW, Boer KR et al (2007) Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 298(8):865–872
Goussous N, Kim BD, Jenkins DH, Zielinski MD (2012) Factors affecting primary fascial closure of the open abdomen in the nontrauma patient. Surgery 152(4):777–783
Petersson U, Acosta S, Bjorck M (2007) Vacuum-assisted wound closure and mesh-mediated fascial traction: a novel technique for late closure of the open abdomen. World J Surg 31(11):2133–2137. doi:10.1007/s00268-007-9222-0
Pliakos I, Papavramidis TS, Mihalopoulos N et al (2010) Vacuum-assisted closure in severe abdominal sepsis with or without retention sutured sequential fascial closure: a clinical trial. Surgery 148(5):947–953
Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Engl J Med 369(9):840–851
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(9):2018–2030. doi:10.1007/s00268-013-2080-z
Bertelsen CA, Fabricius R, Kleif J, Kristensen B, Gogenur I (2013) Outcome of negative-pressure wound therapy for open abdomen treatment after nontraumatic lower gastrointestinal surgery: analysis of factors affecting delayed fascial closure in 101 patients. World J Surg. doi:10.1007/s00268-013-2360-7
Balentine C, Subramanian A, Palacio CH et al (2009) AVAS Best Clinical Resident Award (Tied): management and outcomes of the open abdomen in nontrauma patients. Am J Surg 198(5):588–592
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Atema, J.J., Gans, S.L. & Boermeester, M.A. Systematic Review and Meta-analysis of the Open Abdomen and Temporary Abdominal Closure Techniques in Non-trauma Patients. World J Surg 39, 912–925 (2015). https://doi.org/10.1007/s00268-014-2883-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2883-6