From the Baskent University, Department of General Surgery, Division of Transplantation, Ankara, Turkey.
Exp Clin Transplant. 2022 May;20(Suppl 3):53-55. doi: 10.6002/ect.PediatricSymp2022.O18.
In conditions such as large-for-size syndrome, postreperfusion hepatic edema, and intestinal edema, primary closure of the abdominal wall can cause respiratory complications and thrombosis of vascular structures. Here, we compared results of primary abdominal closure versus a temporary patch closure technique (the Bogota bag technique) in pediatric liver transplant recipients.
We performed primary abdominal closure in 295 recipients. In 39 pediatric liver transplant recipients, the Bogota bag technique was used as the abdominal closure technique because of suspected intraoperative tense abdominal closure. In patients who had the Bogota bag technique, we sutured the sterilized saline bag to the skin at the edge of the defect by shaping the defect so as not to cause abdominal hypertension. Primary abdominal closure was achieved in patients after control laparotomies at 48-hour intervals.
The mean age of the primary abdominal closure group was 8.38 years, whereas the mean age of the Bogota bag group was 2 years. The average weight of patients in the primary abdominal closure group was 26.38 kg, and the average weight of patients in the Bogota bag group was 7.93 kg. Biliary atresia was the most common indication in both groups. Mean length of hospital stay was 21 days in the primary abdominal closure group and 24 days in Bogota bag group. Six patients in the Bogota bag group died from sepsis or bleeding in the early postoperative period. In the Bogota bag group, wound closure was achieved within 2 weeks in 25 patients and within 3 weeks in 8 patients.
Temporary patch closure techniques can be used safely in low-weight and young children, children with large-for-size grafts, and those who display increased intra-abdominal pressure.
在大肝综合征、再灌注后肝水肿和肠水肿等情况下，腹壁的直接缝合可能导致呼吸并发症和血管结构的血栓形成。在此，我们比较了原发性腹壁关闭与临时补丁闭合技术（波哥大袋技术）在小儿肝移植受者中的结果。
我们对 295 例受者进行了原发性腹壁关闭。在 39 例小儿肝移植受者中，由于术中怀疑腹壁紧张，采用波哥大袋技术作为腹壁关闭技术。在采用波哥大袋技术的患者中，我们通过使缺陷成形而不引起腹内高压来将灭菌生理盐水袋缝合到缺陷边缘的皮肤上。在 48 小时间隔进行控制剖腹手术后，患者实现了原发性腹壁关闭。
原发性腹壁关闭组的平均年龄为 8.38 岁，而波哥大袋组的平均年龄为 2 岁。原发性腹壁关闭组患者的平均体重为 26.38 公斤，波哥大袋组患者的平均体重为 7.93 公斤。两组的主要适应证均为胆道闭锁。原发性腹壁关闭组的平均住院时间为 21 天，波哥大袋组为 24 天。波哥大袋组中有 6 例患者在术后早期因感染或出血死亡。在波哥大袋组中，25 例患者在 2 周内完成伤口闭合，8 例患者在 3 周内完成伤口闭合。
在体重低和年幼的儿童、大肝供体的儿童以及显示腹腔内压升高的儿童中，可以安全地使用临时补丁闭合技术。
