Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

Standardization of the strategy for open abdomen in nontrauma emergency laparotomy: A prospective study of outcomes in primary versus temporary abdominal closure

BACKGROUND

The indications for temporary abdominal closure in nontrauma surgery are heterogeneous and with limited data on clinical outcomes. This study aimed to report the outcomes of primary closure compared with temporary abdominal closure after nontrauma emergency laparotomy within a standardized clinical setting adapted from international guidelines.

METHODS

Included were all nontrauma patients undergoing emergency laparotomy between January 1, 2021, and December 31, 2022, at Copenhagen University Hospital Herlev in Denmark. All patients received treatment on the basis of standardized bundle of care trajectory for major emergency abdominal surgery. Mortality, risks of re-laparotomy, and postoperative complications were assessed using Kaplan-Meier plots and multiple logistic regression modeling.

RESULTS

Of the 576 included patients, temporary abdominal closure was performed in 57 (10%) patients in the initial surgery. Indications for temporary abdominal closure included damage control strategy as the result of considerable hemodynamic instability in 21 (37%) patients, need for reassessment of bowel viability in 21 (37%) patients, and loss of domain in 15 (25%) patients. Fascial closure was achieved after a median period of 2 days. Sixty-seven patients (12%) underwent re-laparotomy, with temporary abdominal closure performed in 10 (15%) of the cases. Patients with temporary abdominal closure had a significantly greater risk of postoperative complications (odds ratio 2.58, 95% confidence interval 1.38-4.89, P = .003). There were no significant differences in the risks of fascial dehiscence, re-laparotomy, or 30- or 90-days mortality.

CONCLUSION

Temporary abdominal closure was performed in 10% of patients undergoing nontrauma emergency laparotomy, with the primary indications being damage control strategy and need for reassessment of bowel viability. Patients undergoing temporary abdominal closure had a significantly greater risk of postoperative complications.

Damage Control Surgery and Transfer in Emergency General Surgery

Selective non traumatic emergency surgery patients are targets for damage control surgery (DCS) to prevent or treat abdominal compartment syndrome and the lethal triad. However, DCS is still a subject of controversy. As a concept, DCS describes a series of abbreviated surgical procedures to allow rapid source control of hemorrhage and contamination in patients with circulatory shock to allow resuscitation and stabilization in the intensive care unit followed by delayed return to the operating room for definitive surgical management once the patient becomes physiologic stable. If appropriately applied, the DCS morbidity and mortality can be significantly reduced.

Optimal tentative abdominal closure for open abdomen: a multicenter retrospective observational study (OPTITAC study)

BACKGROUND

Primary fascia closure is often difficult following an open abdomen (OA). While negative-pressure wound therapy (NPWT) is recommended to enhance successful primary fascia closure, the optimal methods and degree of negative pressure remain unclear. This study aimed to elucidate optimal methods of NPWT as a tentative abdominal closure for OA to achieve primary abdominal fascia closure.

MATERIALS AND METHODS

A multicenter, retrospective, cohort study of adults who survived OA greater than 48 h was conducted in 12 institutions between 2010 and 2022. The achievement of primary fascia closure and incidence of enteroatmospheric fistula were examined based on methods (homemade, superficial NPWT kit, or open-abdomen kit) or degrees of negative pressure (<50, 50-100, or >100 mmHg). A generalized estimating equation was used to adjust for age, BMI, comorbidities, etiology for laparotomy requiring OA, vital signs, transfusion, severity of critical illness, and institutional characteristics.

RESULTS

Of the 279 included patients, 252 achieved primary fascia closure. A higher degree of negative pressure (>100 mmHg) was associated with fewer primary fascia closures than less than 50 mmHg [OR, 0.18 (95% CI: 0.50-0.69), P =0.012] and with more frequent enteroatmospheric fistula [OR, 13.83 (95% CI: 2.30-82.93)]. The methods of NPWT were not associated with successful primary fascia closure. However, the use of the open-abdomen kit was related to a lower incidence of enteroatmospheric fistula [OR, 0.02 (95% CI: 0.00-0.50)].

CONCLUSION

High negative pressure (>100 mmHg) should be avoided in NPWT during tentative abdominal closure for OA.