Advertisement

Management of Open Abdomen After Trauma Laparotomy: A Comparative Analysis of Dynamic Fascial Traction and Negative Pressure Wound Therapy Systems

  • Yifan Wang
  • Abdulaziz Alnumay
  • Tiffany Paradis
  • Andrew Beckett
  • Paola Fata
  • Kosar Khwaja
  • Tarek Razek
  • Jeremy Grushka
  • Dan L. DeckelbaumEmail author
Original Scientific Report
  • 27 Downloads

Abstract

Background

Management of the post-traumatic open abdomen (OA) using negative pressure wound therapy (NPWT) alone is associated with low rates of primary fascial closure. The abdominal reapproximation anchor (ABRA) system exerts dynamic medial fascial traction and may work synergistically with NPWT to facilitate primary fascial closure.

Methods

Patients with an OA following trauma laparotomy between 2009 and 2018 were identified from a prospectively maintained institutional database. Patients treated with ABRA in conjunction with NPWT (ABRA) versus NPWT alone (NPWT) were compared in terms of primary fascial closure rate, number of surgeries to closure, tracheostomy duration, length of stay and incidence of entero-atmospheric fistula. Multivariable linear regression was performed to identify predictors of tracheostomy duration.

Results

We identified 48 patients [ABRA, 12 and NPWT, 36]. The ABRA group was significantly younger (25 vs. 37 years, p = 0.027) and included a lower proportion of males (58% vs. 89%, p = 0.032). Groups were similar with respect to the incidence of hollow viscus injury, injury severity score and abdominal abbreviated injury score. Compared to the NPWT group, the ABRA group had a significantly higher rate of primary fascial closure (100% vs. 28%, p < 0.001), fewer surgeries to abdominal closure (2 vs. 2.5, p = 0.023) and shorter duration of tracheostomy (15.5 vs. 36 days, p = 0.008). There were no differences in length of stay or incidence of entero-atmospheric fistula. On multivariable linear regression, ABRA placement was an independent predictor of shorter tracheostomy duration, after adjusting for covariates (β = − 0.294, p = 0.036).

Conclusion

For the post-traumatic OA, ABRA coupled with NPWT achieves a higher rate of primary fascial closure compared to NPWT alone, while requiring fewer surgeries and a shorter duration of tracheostomy.

Notes

Author contributions

The study was designed by YW, AA, TP, AB, PF, KK, TR, JG and DD; data were collected by YW, AA and TP; data were analysed by YW, AA, JG and DD; data were interpreted by YW, AA, JG and DD; manuscript was written by YW, AA, JG and DD; and critical revision was carried out by YW, AA, TP, AB, PF, KK, TR, JG and DD.

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest to disclose.

References

  1. 1.
    Rotondo MF et al (1993) ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35:375–382CrossRefGoogle Scholar
  2. 2.
    Stone HH, Strom PR, Mullins RJ (1983) Management of the major coagulopathy with onset during laparotomy. Ann Surg 197:532–535CrossRefGoogle Scholar
  3. 3.
    Morris JA, Eddy VA, Blinman TA, Rutherford EJ, Sharp KW (1993) The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann Surg 217:576–584CrossRefGoogle Scholar
  4. 4.
    Miller RS, Morris JA, Diaz JJ, Herring MB, May AK (2005) Complications after 344 damage-control open celiotomies. J Trauma 59:1365–1371CrossRefGoogle Scholar
  5. 5.
    Wang Y et al (2018) Incidence and factors associated with development of heterotopic ossification after damage control laparotomy. Injury 49:51–55CrossRefGoogle Scholar
  6. 6.
    Nieuwenhuizen J, Halm JA, Jeekel J, Lange JF (2007) Natural course of incisional hernia and indications for repair. Scand J Surg 96:293–296CrossRefGoogle Scholar
  7. 7.
    Hatch QM et al (2011) Impact of closure at the first take back: complication burden and potential overutilization of damage control laparotomy. J Trauma 71:1503–1511Google Scholar
  8. 8.
    Weinberg JA et al (2008) Closing the open abdomen: improved success with Wittmann Patch staged abdominal closure. J Trauma 65:345–348CrossRefGoogle Scholar
  9. 9.
    Tieu BH et al (2008) The use of the Wittmann Patch facilitates a high rate of fascial closure in severely injured trauma patients and critically ill emergency surgery patients. J Trauma 65:865–870CrossRefGoogle Scholar
  10. 10.
    Mattox KL (1997) Introduction, background, and future projections of damage control surgery. Surg Clin N Am 77:753–759CrossRefGoogle Scholar
  11. 11.
    Ribeiro Junior MAF et al (2016) Open abdomen in gastrointestinal surgery: which technique is the best for temporary closure during damage control? World J Gastrointest Surg 8:590–597CrossRefGoogle Scholar
  12. 12.
    Cheatham ML et al (2013) Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique. World J Surg 37:2018–2030CrossRefGoogle Scholar
  13. 13.
    Cirocchi R et al (2016) What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis. J Trauma Acute Care Surg 81:575–584CrossRefGoogle Scholar
  14. 14.
    Mukhi AN, Minor S (2014) Management of the open abdomen using combination therapy with ABRA and ABThera systems. Can J Surg 57:314–319CrossRefGoogle Scholar
  15. 15.
    Verdam FJ et al (2011) Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg 35:2348–2355CrossRefGoogle Scholar
  16. 16.
    Haddock C, Konkin DE, Blair NP (2013) Management of the open abdomen with the abdominal reapproximation anchor dynamic fascial closure system. Am J Surg 205:528–533CrossRefGoogle Scholar
  17. 17.
    Reimer MW et al (2008) Management of open abdominal wounds with a dynamic fascial closure system. Can J Surg 51:209–214Google Scholar
  18. 18.
    Baker SP, O'Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196CrossRefGoogle Scholar
  19. 19.
    Brock WB, Barker DE, Burns RP (1995) Temporary closure of open abdominal wounds: the vacuum pack. Am Surg 61:30–35Google Scholar
  20. 20.
    Olona C et al (2014) Comparative study of open abdomen treatment: ABThera™ vs. abdominal dressing™. Hernia 19:323–328CrossRefGoogle Scholar
  21. 21.
    Lee JC, Peitzman AB (2006) Damage-control laparotomy. Curr Opin Crit Care 12:346–350CrossRefGoogle Scholar
  22. 22.
    Kritayakirana K et al (2010) Outcomes and complications of open abdomen technique for managing non-trauma patients. J Emerg Trauma Shock 3:118–122CrossRefGoogle Scholar
  23. 23.
    Desai NK et al (2016) Open repair of large abdominal wall hernias with and without components separation; an analysis from the ACS-NSQIP database. Ann Med Surg 7:14–19CrossRefGoogle Scholar
  24. 24.
    Richter S, Dold S, Doberauer JP, Mai P, Schuld J (2013) Negative pressure wound therapy for the treatment of the open abdomen and incidence of enteral fistulas: a retrospective bicentre analysis. Gastroenterol Res Pract 2013:6CrossRefGoogle Scholar
  25. 25.
    Rasilainen SK, Mentula PJ, Leppäniemi AK (2012) Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg 99:1725–1732CrossRefGoogle Scholar
  26. 26.
    Bradley MJ et al (2013) Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST open abdomen registry. JAMA Surg 148:947–954CrossRefGoogle Scholar
  27. 27.
    Coccolini F et al (2017) IROA: international register of open abdomen, preliminary results. World J Emerg Surg 12:10–10CrossRefGoogle Scholar
  28. 28.
    Coccolini F et al (2019) Open abdomen and entero-atmospheric fistulae: an interim analysis from the international register of open abdomen (IROA). Injury 50:160–166CrossRefGoogle Scholar
  29. 29.
    Lynch AC et al (2004) Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Ann Surg 240:825–831CrossRefGoogle Scholar
  30. 30.
    Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481CrossRefGoogle Scholar
  31. 31.
    Isik A et al (2016) Effectiveness of manual knotting at laparoscopic appendectomy. Gazi Med J 27:19–20Google Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Yifan Wang
    • 1
  • Abdulaziz Alnumay
    • 1
  • Tiffany Paradis
    • 1
  • Andrew Beckett
    • 1
  • Paola Fata
    • 1
  • Kosar Khwaja
    • 1
  • Tarek Razek
    • 1
    • 2
  • Jeremy Grushka
    • 1
  • Dan L. Deckelbaum
    • 1
    • 2
    Email author
  1. 1.Division of Trauma Surgery, McGill University Health CentreMcGill UniversityMontrealCanada
  2. 2.Centre for Global SurgeryMcGill UniversityMontrealCanada

Personalised recommendations