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Langenbeck's Archives of Surgery

, Volume 401, Issue 5, pp 619–625 | Cite as

High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis—a retrospective analysis

  • Ioannis Mintziras
  • Michael Miligkos
  • Detlef Klaus Bartsch
ORIGINAL ARTICLE

Abstract

Purpose

The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation.

Methods

The hospital OPS-database (time period 2005–2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients’ characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation.

Results

Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24–90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3–88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13 days.

Conclusions

Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

Keywords

Vacuum-assisted closure therapy Peritonitis Open abdomen Enterocutaneous fistula 

Notes

Authors’ contributions

I.M. is responsible for the study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript; M.M is responsible for the study conception and design, analysis and interpretation of data, and critical revision of manuscript; D.B.is responsible for the study conception and design, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    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):365–368CrossRefPubMedGoogle Scholar
  2. 2.
    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. doi: 10.1159/000314609 CrossRefPubMedGoogle Scholar
  3. 3.
    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 8(1):63–72CrossRefGoogle Scholar
  4. 4.
    Fortelny RH, Hofmann A, Gruber-Blum S, Petter-Puchner AH, Glaser KS (2014) Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial closure. Surg Endosc 28(3):735–740. doi: 10.1007/s00464-013-3251-6 CrossRefPubMedGoogle Scholar
  5. 5.
    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):1725–1732CrossRefPubMedGoogle Scholar
  6. 6.
    Bertelsen CA, Fabricius R, Kleif J, Kristensen B, Gögenur I (2014) 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 38(4):774–781. doi: 10.1007/s00268-013-2360-7 CrossRefPubMedGoogle Scholar
  7. 7.
    Roberts D, Zygun A et al (2012) Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review. J Trauma Acute Care Surg 73:629–639CrossRefPubMedGoogle Scholar
  8. 8.
    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 CrossRefPubMedGoogle Scholar
  9. 9.
    Rao M, Burke D, Finan PJ, Sagar PM (2007) The use of vacuum-assisted closure of abdominal wounds: a word of caution. Color Dis 9(3):266–268CrossRefGoogle Scholar
  10. 10.
    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):274–279CrossRefPubMedGoogle Scholar
  11. 11.
    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):777–783CrossRefPubMedGoogle Scholar
  12. 12.
    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 2013:730829CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP (2000) Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma 48(2):201–206, discussion 206–7CrossRefPubMedGoogle Scholar
  14. 14.
    Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N (2014) Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg 12(10):1105–1114. doi: 10.1016/j.ijsu.2014.08.396 CrossRefPubMedGoogle Scholar
  15. 15.
    Björck M, Bruhin A, Cheatham M, Hinck D, Kaplan M, Manca G, Wild T, Windsor A (2009) Classification: important step to improve management of patients with an open abdomen. World J Surg 33(6):1154–1157. doi: 10.1007/s00268-009-9996-3 CrossRefPubMedGoogle Scholar
  16. 16.
    Brock WB, Barker DE, Burns RP (1995) Temporary closure of open abdominal wounds: the vacuum pack. Am Surg 61(1):30–35PubMedGoogle Scholar
  17. 17.
    Kreis BE et al (2013) Open abdomen management: a review of its history and a proposed management algorithm. Med Sci Monit 19:524–533. doi: 10.12659/MSM.883966 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    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(5):843–849, 2002CrossRefPubMedGoogle Scholar
  19. 19.
    Garner GB, Ware DN, Cocanour CS et al (2001) Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg 182:630–638CrossRefPubMedGoogle Scholar
  20. 20.
    van Hensbroek PB, 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 CrossRefGoogle Scholar
  21. 21.
    Quyn AJ, Johnston C, Hall D et al (2012) The open abdomen and temporary abdominal closure systems—historical evolution and systematic review. Color Dis 14(8):e429–e438CrossRefGoogle Scholar
  22. 22.
    Atema JJ, Gans SL, Boermeester MA (2015) Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg 39(4):912–925. doi: 10.1007/s00268-014-2883-6 CrossRefPubMedGoogle Scholar
  23. 23.
    Lindner MM et al.: Welche klinischen Faktoren beeinflussen die Letalität bei bakterieller Peritonitis: Mannheimer Peritonitis-Index (MPI). In: Langenbeck‘s Archives of Surgery. Bd.369,, Springer Berlin / Heidelberg,, 1986, ISSN 1435–2451, S. 788.Google Scholar
  24. 24.
    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):957–961PubMedGoogle Scholar
  25. 25.
    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(6):1154–1159. doi: 10.1097/SLA.0b013e31828b8bc8 CrossRefPubMedGoogle Scholar
  26. 26.
    Huang Q, Zhao R, Yue C et al (2014) Fluid volume overload negatively influences delayed primary facial closure in open abdomen management. J Surg Res 187(1):122–127. doi: 10.1016/j.jss.2013.09.032 CrossRefPubMedGoogle Scholar
  27. 27.
    Prichayudh S, Sriussadaporn S, Samorn P et al (2011) Management of open abdomen with an absorbable mesh closure. Surg Today 41(1):72–78CrossRefPubMedGoogle Scholar
  28. 28.
    Lopez-Quintero L et al (2010) Treatment of open abdomen in patients with abdominal sepsis using the vacuum pack system. Cir Cir 78(4):322–326PubMedGoogle Scholar
  29. 29.
    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. doi: 10.1080/110241500750009690 CrossRefPubMedGoogle Scholar
  30. 30.
    Ozguc H, Paksoy E, Ozturk E (2008) Temporary abdominal closure with the vacuum pack technique: a 5-year experience. Acta Chir Belg 108(4):414–419CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ioannis Mintziras
    • 1
  • Michael Miligkos
    • 2
  • Detlef Klaus Bartsch
    • 1
  1. 1.Department of Visceral, Thoracic and Vascular SurgeryPhilipps-University MarburgMarburgGermany
  2. 2.Laboratory of BiomathematicsUniversity of Thessaly School of MedicineLarissaGreece

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