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World Journal of Surgery

, Volume 39, Issue 4, pp 912–925 | Cite as

Systematic Review and Meta-analysis of the Open Abdomen and Temporary Abdominal Closure Techniques in Non-trauma Patients

  • J. J. Atema
  • S. L. Gans
  • M. A. Boermeester
Scientific Review

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.

Keywords

Abdominal Compartment Syndrome Open Abdomen Negative Pressure Wound Therapy Fascial Closure Temporary Abdominal Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

None.

Supplementary material

268_2014_2883_MOESM1_ESM.doc (25 kb)
Supplementary material 1 (DOC 25 kb)
268_2014_2883_MOESM2_ESM.doc (382 kb)
Supplementary material 2 (DOC 382 kb)
268_2014_2883_MOESM3_ESM.doc (296 kb)
Supplementary material 3 (DOC 296 kb)

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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  1. 1.Department of Surgery (G4-142)Academic Medical CenterAmsterdamThe Netherlands

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