Central Surgical AssociationFactors affecting primary fascial closure of the open abdomen in the nontrauma patient
Section snippets
Material and methods
Institutional review board approval was obtained to retrospectively analyze patients admitted with an OA from December 2006 to June 2010. Patients were excluded if their OA was a result of trauma, if they were younger than 18 years of age, or if they died before an attempt at fascial closure. Data from patients who underwent a primary fascial closure were compared with those in whom primary fascial closure could not be achieved (ie, planned ventral hernia or partial fascial closure). Cumulative
Results
A total of 181 patients were identified, of which 8 patients died before fascial closure attempt, leaving a total of 173 patients constituting the study cohort (n = 88 male). The mean age was 63 years. The majority of patients underwent OA resulting from general operative procedures (90%) with the remaining after vascular operations (10%). Concern regarding bowel viability and fecal contamination each accounted for approximately one-third of the indications for OA, whereas loss of domain
Discussion
The use of the OA technique has been advocated in many disease processes by acute-care surgeons. Its application allows for serial abdominal examinations and treatments such as ischemic bowel resection, debridement of necrotic/infected material, and hemorrhage control.13, 14 The use of the OA technique improves mortality rates not only in trauma patients but also in critically ill nontrauma populations with intra-abdominal catastrophes. For example, in the setting of abdominal compartment
References (18)
- et al.
Long-term impact of abdominal decompression: a prospective comparative analysis
J Am Coll Surg
(2008) - et al.
Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study
J Vasc Surg
(2002) - et al.
Management of the major coagulopathy with onset during laparotomy
Ann Surg
(1983) - et al.
“Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury
J Trauma
(1993) - et al.
Temporary abdominal closure: long-term outcomes
J Trauma
(2011) - et al.
The management of the open abdomen in trauma and emergency general surgery: part 1-damage control
J Trauma
(2010) - et al.
The open abdomen in trauma: do infectious complications affect primary abdominal closure?
Surg Infect
(2006) - et al.
Long-term physical, mental, and functional consequences of abdominal decompression
J Trauma
(2004) - et al.
Quality of life after abdominal wall reconstruction following open abdomen
J Trauma
(2011)
Cited by (35)
Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm
2024, European Journal of Vascular and Endovascular SurgeryDamage Control Surgery and Transfer in Emergency General Surgery
2023, Surgical Clinics of North AmericaSupine position and nonmodifiable risk factors for ventilator-associated pneumonia in trauma patients
2017, American Journal of SurgeryCitation Excerpt :In patients with an open abdomen, permanent visceral coverage, preferably with primary fascial closure, is an important goal of care to avoid the dreaded complications of enteric fistula or abdominal sepsis.13,14 Patients with an open abdomen are often ventilator-dependent for longer periods15 and difficult to mobilize, increasing their risk of ICU complications including VAP. Because of this, factors that delay or complicate abdominal closure should be avoided.
Outcomes of primary fascial closure after open abdomen for nontrauma emergency general surgery patients
2015, American Journal of SurgeryCitation Excerpt :Interestingly, the time to closure, number of washouts, type of closure (running vs interrupted), indication for initial operation, fluid balance, and intervention performed did not affect fascial complication rates. PFC was attempted in 64% of patients, which is within the range of 24% to 74% reported in the literature for nontrauma3,6,12,13 as well as trauma OA patients (59% to 100%).7,14–16 Cothren et al16 have described sequential fascial closure resulting in 100% fascial closure in a series of 100 injured patients managed with damage control techniques.
Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy
2014, Surgery (United States)Citation Excerpt :Given that fluids follow the path of least resistance, an open abdominal cavity may, in fact, facilitate increased bowel edema and distention of abdominal contents, which might otherwise not occur in a closed abdominal cavity.19 In the initial publication from the AAST Open Abdomen database, Dubose et al7 noted that the number of re-explorations was highly correlated with failure to achieve primary fascial closure, and this was seconded by Bradley et al20 in their examination of the risk factors for development of enterocutaneous fistulae.21 In the nontrauma population, Zielinski's group noted increased primary fascial closure with fewer days of OA management as well as fewer reexplorations.18
Fluid volume overload negatively influences delayed primary facial closure in open abdomen management
2014, Journal of Surgical ResearchCitation Excerpt :Selewski et al. [21] compared weight-based methods versus the fluid balance method for calculating fluid overload, suggesting weight-based definitions of fluid overload are more useful and practical, as used at the bedside in our study. Recently, Goussous et al. [22] tried to identify factors preventing primary fascial closure after damage control laparotomy in nontrauma patients. They found that success of primary fascial closure was associated with a lower fluid balance over the first 10 d. However, it must be pointed that in our study, the rate of patients with severe intra-abdominal infection plus trauma was high (90%).