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Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study

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Abstract

Introduction

Negative pressure wound therapy (NPWT) is widely used in the treatment of open abdomen (OA). The use of dynamic fascial sutures (DFS) increases the rate of successful delayed closure by reducing fascial lateralization. We recently published a prospective controlled trial including 87 patients undergoing abdominal surgery for secondary peritonitis between 2007 and 2012. Patients were treated with NPWT and DFS for approximation of fascial edges. The present study represents a follow-up assessment of these patients 5–9 years after OA treatment with NPWT and DFS.

Methods

The 39 patients still alive were included in the recent study according to the protocol of our last study in 2013. All patients received a questionnaire regarding long-term complications after OA treatment between 2007 and 2012. Mean follow-up was 5–9 years. Analyzed parameters included pain, the presence of incisional hernia, and subsequent surgical interventions. Results were analyzed quantitatively.

Results

One patient had deceased since the last publication in 2013, and hence 38 patients were included in the current study. The median age was 60.9 (25.2–86.1) years, and 17 (44.7%) were females. Overall 56.3% of the original 87 patients had died during the long-term follow-up period. 21 patients (55.3%) answered the questionnaire. Six (28.6%) declared that they suffered from pain in the previous operating field, five (23.8%) at rest, and three (14.3%) during exercise. In five patients (23.8%), pain lasted for more than 3 months. One patient (4.8%) still requires analgesic treatment. Among the 21 patients, seven (33.3%) were found to have incisional hernias. Three hernias (42.9%) were treated by surgery.

Conclusion

Incisional hernia rates after OA treatment remain high, but are accompanied by little pain. The ideal technique of fascial closure after NPWT should be investigated in further research.

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Acknowledgements

The authors thank Ilse Jung for statistical analysis.

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Authors and Affiliations

  1. Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria

    Anna Theresa Hofmann, Simone Gruber-Blum, Alexander Petter-Puchner, Karl Glaser & René Fortelny

  2. Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    Michael Lechner

  3. Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria

    René Fortelny

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  1. Anna Theresa Hofmann
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  2. Simone Gruber-Blum
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  4. Alexander Petter-Puchner
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  5. Karl Glaser
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  6. René Fortelny
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Correspondence to Anna Theresa Hofmann.

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Disclosures

Drs. Anna Theresa Hofmann, Simone Gruber-Blum, Michael Lechner, Alexander Petter-Puchner, Karl Glaser, and René Fortelny have no conflicts of interest or financial ties to disclose.

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Hofmann, A.T., Gruber-Blum, S., Lechner, M. et al. Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study. Surg Endosc 31, 4717–4724 (2017). https://doi.org/10.1007/s00464-017-5547-4

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  • DOI: https://doi.org/10.1007/s00464-017-5547-4

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