Abstract
Purpose
The open abdomen has become a standard technique in the management of critically ill patients undergoing surgery for severe intra-abdominal conditions. Negative pressure and mesh-mediated fascial traction are commonly used and achieve low fistula rates and high fascial closure rates. In this study, long-term results of a standardised treatment approach are presented.
Methods
Fifty-five patients who underwent OA management for different indications at our institution from 2006 to 2013 were enrolled. All patients were treated under a standardised algorithm that uses a combination of vacuum-assisted wound closure and mesh-mediated fascial traction. Structured follow-up assessments were offered to patients and included a medical history, a clinical examination and abdominal ultrasonography. The data obtained were statistically analysed.
Results
The fascial closure rate was 74 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. The fistula rate was 1.8 %. Thirty-four patients attended follow-up. The median follow-up was 46 months (range 12–88 months). Incisional hernias developed in 35 %. Patients with hernias needed more operative procedures (10.3 vs 3.4, p = 0.03) than patients without hernia formation. A Patient Observer Scar Assessment Scale (POSAS) of 31.1 was calculated. Patients with symptomatic hernias (NAS of 2–10) had a significantly lower mean POSAS score (p = 0.04).
Conclusions
Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) seem to result in low complication rates and high fascial closure rates. Abdominal wall reconstruction, which is a challenging and complex procedure and causes considerable patient discomfort, can thus be avoided in the majority of cases. Available results are based on studies involving only a small number of cases. Multi-centre studies and registry-based data are therefore needed to validate these findings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O et al (2015) The open abdomen, indications, management and definitive closure. World J Emerg Surg 10:32
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 12:1105–1114 (London, England)
Kafka-Ritsch R, Birkfellner F, Perathoner A, Raab H, Nehoda H et al (2012) Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV. J Gastrointest Surg 16:1915–1922
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 39:912–925
Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA et al (2015) The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg 10:35
Acosta S, Bjarnason T, Petersson U, Pålsson B, Wanhainen A et al (2011) Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg 98:735–743
Willms A, Güsgen C, Schaaf S, Bieler D, von Websky M et al (2015) Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction. Langenbecks Arch Surg 400:91–99
Petersson U, Acosta S, Björck M (2007) Vacuum-assisted wound closure and mesh-mediated fascial traction–a novel technique for late closure of the open abdomen. World J Surg 31:2133–2137
Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O et al (2013) Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 74:113–120 (discussion 1120-2)
Scott BG, Welsh FJ, Pham HQ, Carrick MM, Liscum KR et al (2006) Early aggressive closure of the open abdomen. J Trauma 60:17–22
Pliakos I, Papavramidis TS, Mihalopoulos N, Koulouris H, Kesisoglou I et al (2010) Vacuum-assisted closure in severe abdominal sepsis with or without retention sutured sequential fascial closure: a clinical trial. Surgery 148:947–953
Dietz UA, Wichelmann C, Wunder C, Kauczok J, Spor L 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 16:451–460
Conze J, Binnebösel M, Junge K, Schumpelick V (2010) Incisional hernia—how do I do it? Standard surgical approach. Chirurg 81:192–200
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526
Willms A, Güsgen C, Schreyer C, Becker HP, Schwab R (2011) Prevention of small bowel fistulas during open abdominal treatment: lessons learned. Zentralbl Chir 136:592–597
Brandl A, Laimer E, Perathoner A, Zitt M, Pratschke J et al (2014) Incisional hernia rate after open abdomen treatment with negative pressure and delayed primary fascia closure. Hernia 18:105–111
Bjarnason T, Montgomery A, Ekberg O, Acosta S, Svensson M et al (2013) One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction. World J Surg 37:2031–2038
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 28:735–740
Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251:843–856
Scholtes M, Kurmann A, Seiler CA, Candinas D, Beldi G (2012) Intraperitoneal mesh implantation for fascial dehiscence and open abdomen. World J Surg 36:1557–1561
Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS (2015) What score on the Vancouver scar scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers. Burns 41:1442–1448
Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS et al (2015) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40:89–99
El-Khadrawy OH, Moussa G, Mansour O, Hashish MS (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13:267–274
Herrle F, Hasenberg T, Fini B, Jonescheit J, Shang E et al (2011) Open abdomen 2009. A national survey of open abdomen treatment in Germany. Chirurg 82:684–690
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest. The results reported here have been presented in a yet unpublished doctoral thesis.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Willms, A., Schaaf, S., Schwab, R. et al. Abdominal wall integrity after open abdomen: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). Hernia 20, 849–858 (2016). https://doi.org/10.1007/s10029-016-1534-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-016-1534-2