Berrevoet Frederik, Lampaert Silvio, Singh Kashika, Jakipbayeva Kamilya, van Cleven Stijn, Vanlander Aude
Department of General and Hepatopancreaticobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
Front Surg. 2021 Feb 9;7:606539. doi: 10.3389/fsurg.2020.606539. eCollection 2020.
The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Complete fascial closure is an essential treatment objective and can be achieved by the use of different dynamic closure techniques. Both surgical technique and-decision making are essential for optimal patient outcome in terms of fascial closure. The aim of this study was to analyse patients' outcome after the use of mesh-mediated fascial traction (MMFT) associated with negative pressure wound therapy (NPWT) and identify important factors that negatively influenced final fascial closure. A single center ambispective analysis was performed including all patients treated for an open abdomen in a tertiary referral center from 3/2011 till 2/2020. All patients with a minimum survival >24 h after initiation of treatment were analyzed. The data concerning patient management was collected and entered into the Open Abdomen Route of the European Hernia Society (EHS). Patient basic characteristics considering OA indication, primary fascial closure, as well as important features in surgical technique including time after index procedure to start mesh mediated fascial traction, surgical closure techniques and patients' long-term outcomes were analyzed. Data were obtained from 152 patients who underwent open abdomen therapy (OAT) in a single center study. Indications for OAT as per-protocol analysis were sepsis (33.3%), abdominal compartment syndrome (31.6%), followed by peritonitis (24.2%), abdominal trauma (8.3%) and burst abdomen (2.4%). Overall fascial closure rate was 80% as in the per-protocol analysis. When patients that started OA management with MMFT and NPWT from the initial surgery a significantly better fascial closure rate was achieved compared to patients that started 3 or more days later ( < 0.001). An incisional hernia developed in 35.8% of patients alive with a median follow-up of 49 months (range 6-96 months). Our main findings emphasize the importance of a standardized treatment plan, initiated early on during management of the OA. The use of vacuum assisted closure in combination with MMFT showed high rates of fascial closure. Absence of initial intraperitoneal NPWT as well as delayed start of MMFT were risk factors for non-fascial closure. Initiation of OA with VACM should not be unnecessary delayed.
开放腹腔（OA）是处理腹腔内严重病变的重要方法，并且仍然是治疗的标准方式。完全筋膜闭合是一项重要的治疗目标，可通过使用不同的动态闭合技术来实现。手术技术和决策对于筋膜闭合方面的最佳患者预后都至关重要。本研究的目的是分析使用网状物介导的筋膜牵引（MMFT）联合负压伤口治疗（NPWT）后的患者预后，并确定对最终筋膜闭合产生负面影响的重要因素。进行了一项单中心双向分析，纳入了2011年3月至2020年2月在一家三级转诊中心接受开放腹腔治疗的所有患者。分析了所有治疗开始后存活至少24小时的患者。收集有关患者管理的数据并录入欧洲疝学会（EHS）的开放腹腔路径。分析了与OA指征、初次筋膜闭合相关的患者基本特征，以及包括索引手术后开始网状物介导的筋膜牵引的时间、手术闭合技术和患者长期预后等手术技术中的重要特征。数据来自一项单中心研究中152例接受开放腹腔治疗（OAT）的患者。根据方案分析，OAT的指征为脓毒症（33.3%）、腹腔间隔室综合征（31.6%），其次是腹膜炎（24.2%）、腹部创伤（8.3%）和腹壁裂开（2.4%）。如方案分析所示，总体筋膜闭合率为80%。与在初次手术后3天或更长时间开始MMFT和NPWT的患者相比，从初次手术就开始OA管理的患者筋膜闭合率明显更高（<0.001）。中位随访49个月（范围6 - 96个月）时，35.8%存活患者发生了切口疝。我们的主要研究结果强调了在OA管理早期启动标准化治疗方案的重要性。真空辅助闭合联合MMFT显示出较高的筋膜闭合率。未进行初始腹腔内NPWT以及MMFT开始延迟是筋膜未闭合的危险因素。不应不必要地延迟使用VACM启动OA治疗。
