Abstract
Hemodynamic resuscitation, source control, and delayed abdominal closure are the three fundamental steps for open abdomen (OA) management. When to start delayed abdominal closure and how to determine which delayed closure method should be applied to each OA patient are not clarified in the literature. We evaluated an algorithm that was developed to address these two questions. A retrospective chart review was conducted for OA patients treated for according to the algorithm. When hemodynamic stabilization and source control using negative pressure therapy resulted in regression of sepsis and decreased procalcitonin levels, patients were assigned to either the skin-only or fascial closure groups according to their Björck scores and open abdominal fascial closure (OAFC) scores. The novel OAFC scoring system was created by adding age and malignancy to the sequential organ failure assessment (SOFA) score. For skin-only closure, skin flaps and skin grafts were used; for fascial closure, an abdominal re-approximation anchor system (ABRA) or ABRA plus biologic mesh was applied. From January 2008 through September 2014, 108 OA patients were managed based on the algorithm; 61 were included in this study. Abdominal closure rate was 90.2 % (55/61). Overall hospital mortality rate was 11.4 % (7/61). Small hernias developed in only 12.5 % (4/32) of the fascial closure group. In this retrospective study, the algorithm with the novel OAFC score provided practical and valid guidance to clarify when to start delayed abdominal closure and which delayed closure method to use for each OA patient.
Similar content being viewed by others
References
Bjorck M, D’Amours SK, Hamilton A (2011) Closure of the open abdomen. Am Surg 77(Suppl 1):S58–S61
Regner JL, Kobayashi L, Coimbra R (2012) Surgical strategies for management of the open abdomen. World J Surg 36:497–510
Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA et al (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54:848–861
Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien PA (2007) Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 205:586–592
Verdam FJ, Dolmans DE, Loos MJ, Raber MH, de Wit RJ, Charbon JA et al (2011) Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg 35:2348–2355
Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Carel Goslings J (2009) Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg 33:199–207
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 70:652–656
Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G et al (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238:349–357
Marinis A, Gkiokas G, Argyra E, Fragulidis G, Polymeneas G, Voros D (2013) “Enteroatmospheric fistulae”—gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg 102:61–68
Becker HP, Willms A, Schwab R (2007) Small bowel fistulas and the open abdomen. Scand J Surg 96:263–271
Suliburk JW, Ware DN, Balogh Z, McKinley BA, Cocanour CS, Kozar RA et al (2003) Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma 55(6):1155–1160
Salman AE, Yetisir F, Aksoy M, Tokac M, Yildirim MB, Kilic M (2014) Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen. Hernia 18(1):99–104
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Jones AE, Trzeciak S, Kline JA (2009) The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 37:1649–1654
Torer N, Yorganci K, Elker D, Sayek I (2010) Prognostic factors of the mortality of postoperative intraabdominal infections. Infection 38:255–260
Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B et al (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society Of The Abdominal Compartment Syndrome. Intensive Care Med 39:1190–1206
Bjorck M, Wanhainen A (2014) Management of abdominal compartment syndrome and the open abdomen. Eur J Vasc Endovasc Surg 47:279–287
Yetisir F, Salman AE, Aygar M, Yaylak F, Aksoy M, Yalcin A (2014) Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system. Int J Surg Case Rep 5:385–388
Yetisir F, Salman AE, Mamedov R, Aksoy M, Yalcin A, Kayaalp C (2014) Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: a case report. Int J Surg Case Rep 5:164–168
Kibe S, Adams K, Barlow G (2011) Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother 66(Suppl 2):ii33–ii40
Minne L, Abu-Hanna A, de Jonge E (2008) Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care 12:R161
Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L et al (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working group on sepsis related problems of the ESICM. Intensive Care Med 25:686–696
Yetisir F, Salman AE, Ozdemir F, Durak D, Ozlu O, Kilic M (2013) Modified application of dynamic wound closure system in the management of septic open abdomen. World J Traumatol Crit Care Med 1:1–8
Bjorck M, Bruhin A, Cheatham M, Hinck D, Kaplan M, Manca G et al (2009) Classification-important step to improve management of patients with an open abdomen. World J Surg 33:1154–1157
Kubiak BD, Albert SP, Gatto LA, Snyder KP, Maier KG, Vieau CJ et al (2010) Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischemia/reperfusion model. Shock 34:525–534
Quyn AJ, Johnston C, Hall D, Chambers A, Arapova N, Ogston S et al (2012) The open abdomen and temporary abdominal closure systems—historical evolution and systematic review. Color Dis 14:e429–e438
Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL (2008) Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg 247:440–444
Acosta S, Bjarnason T, Petersson U, Palsson B, Wanhainen A, Svensson M 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
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Yetisir, F., Sarer, A.E., Acar, H.Z. et al. Delayed Closure of 61 Open Abdomen Patients Based on an Algorithm. Indian J Surg 79, 38–44 (2017). https://doi.org/10.1007/s12262-015-1422-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-015-1422-5