Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Grande Rio University, Rio de Janeiro, Brazil.
World J Surg. 2024 Oct;48(10):2391-2399. doi: 10.1002/wjs.12336. Epub 2024 Sep 7.
Open abdomen (OA) therapy is used in the management of patients who require surgery for severe abdominal conditions. This meta-analysis aims to evaluate the VAWCM technique regarding short and long-term outcomes.
PubMed, Embase, and Cochrane Central were systematically searched for studies that analyzed VAWCM therapy in OA. Primary outcomes were the complete fascial closure rate and mean duration of OA treatment. Statistical analyses were performed using R statistical software.
Seven studies comprising 535 patients were included. We found a complete fascial closure rate of 77.3 per 100 patients (80.1%; 95% CI 59.6-88.7; I = 76%), with an overall mortality of 30.3 per 100 (33.5%; 95% CI 9.3-19.4; I = 78%). The pooled mean duration of OA treatment was 14.6 days (95% CI 10.7-18.6; I = 93%), while the mean length of hospital stay was 43.3 days (95% CI 21.2-65.3; I = 96%). As additional outcomes, we found an enteroatmospheric fistula rate of 5.6 per 100 patients (5.4%; 95% CI 2.3-13.3; I = 45%) and incisional hernia rate of 34.7 per 100 (34.6%; 95% CI 28.9-41.1; I = 0%). The subgroup analysis of mesh materials (polypropylene or polyglactin) showed a higher complete fascial closure rate for the polyglactin (89.1% vs. 66.6%; p = 0.02).
Our findings showed that VAWCM is a viable option for OA treatment, successfully reaching complete fascial closure, with a low duration of the technique, even though it presented a high heterogeneity between the studies.
开放式腹部（OA）治疗用于需要手术治疗严重腹部疾病的患者。本荟萃分析旨在评估 VAWCM 技术的短期和长期结果。
系统检索了 PubMed、Embase 和 Cochrane Central 中分析 OA 中 VAWCM 治疗的研究。主要结局是完全筋膜闭合率和 OA 治疗的平均持续时间。使用 R 统计软件进行统计分析。
纳入了 7 项包含 535 例患者的研究。我们发现 100 例患者中有 77.3 例（77.3/100；95%CI59.6-88.7；I=76%）完全筋膜闭合，总体死亡率为 100 例中有 30.3 例（30.3/100；95%CI9.3-19.4；I=78%）。OA 治疗的平均持续时间为 14.6 天（95%CI10.7-18.6；I=93%），平均住院时间为 43.3 天（95%CI21.2-65.3；I=96%）。作为额外的结局，我们发现肠腔瘘的发生率为 100 例中有 5.6 例（5.6/100；5.4%95%CI2.3-13.3；I=45%）和切口疝的发生率为 100 例中有 34.7 例（34.7/100；34.6%95%CI28.9-41.1；I=0%）。对网片材料（聚丙烯或聚乳酸）的亚组分析显示，聚乳酸的完全筋膜闭合率更高（89.1%比 66.6%；p=0.02）。
我们的研究结果表明，VAWCM 是治疗 OA 的可行选择，可成功达到完全筋膜闭合，技术持续时间短，尽管研究之间存在高度异质性。
