The best closure techniques in patients treated with open abdomen: Proposal for an algorithm

Abstract text (incl. references and figure legends)

Background: several abdominal wound closure techniques are available to achieve wound closure in post-traumatic and septic open abdomen (OA). Currently, OA-negative pressure therapy (OA-NPT) and mesh mediated fascial traction are usually the first choice. However, there is not an algorithm to follow in order to offer the best patient tailored approach. Materials and Methods: a retrospective analysis of outcomes of 50 patients treated with open abdomen was performed. They were divided in groups according to the OA treatment, Bogota-bag (BB) vs OA-NPT, and the different closure techniques applied, such as direct closure, mesh mediated closure and closure achieved performing components separation. Results: OA-NPT was associated to a longer hospital stay and OA treatment length compared to BB (in both cases p < 0.001). Definitive closure was achieved in all the thirty-two surviving patients. DC was performed in 17 patients. Among these, 7 were treated with BB and 10 with NPT without any difference in the DC rate (p 0.7). 15/32 patients underwent Ramirez component separation. There was no difference between DC and CS groups for the number of re-operation before definitive closure, but hospital stay was longer in patients treated with CS (37 vs 28 days, p < 0.001). Overall, 11 patients were managed with mesh mediated traction that did not determine any difference in terms of bleeding, mortality and post incisional hernia rates, but the ICU stay was slightly longer and close to the statistical significance level (p 0.07). Conclusion: the use of OA-NPT is an established technique worldwide. In accordance with our results, we propose an algorithm that could suggest which treatment choose and when. Further prospective studies on larger cohorts are needed to validate it.

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