Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment
Open Access
- 19 July 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in Hernia
- Vol. 22 (5), 785-792
- https://doi.org/10.1007/s10029-018-1798-9
Abstract
Background Open abdomen (OA) may be required in patients with abdominal trauma, sepsis or compartment syndrome. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a widely used approach for temporary abdominal closure to close the abdominal wall. However, this method is associated with a high incidence of re-operations in short term and late sequelae such as incisional hernia. The current study aims to compare the results of surgical strategies of OA with versus without permanent mesh augmentation. Methods Patients with OA treatment undergoing vacuum-assisted wound closure and an intraperitoneal onlay mesh (VAC-IPOM) implantation were compared to VAWCM with direct fascial closure which represents the current standard of care. Outcomes of patients from two tertiary referral centers that performed the different strategies for abdominal closure after OA treatment were compared in univariate and multivariate regression analysis. Results A total of 139 patients were included in the study. Of these, 50 (36.0%) patients underwent VAC-IPOM and 89 (64.0%) patients VAWCM. VAC-IPOM was associated with reduced re-operations (adjusted incidence risk ratio 0.48 per 10-person days; CI 95% = 0.39–0.58, p < 0.001), reduced duration of stay on intensive care unit (ICU) [adjusted hazard ratio (aHR) 0.53; CI 95% = 0.36–0.79, p = 0.002] and reduced hospital stay (aHR 0.61; CI 95% = 0.040–0.94; p = 0.024). In-hospital mortality [22.5 vs 18.0%, risk difference − 4.5; confidence interval (CI) 95% = − 18.2 to 9.3; p = 0.665] and the incidence of intestinal fistula (18.0 vs 22.0%, risk difference 4.0; CI 95% = −10.0 to 18.0; p = 0.656) did not differ between the two groups. In Kaplan–Meier analysis, hernia-free survival was significantly increased after VAC-IPOM (p = 0.041). Conclusions In patients undergoing OA treatment, intraperitoneal mesh augmentation is associated with a significantly decreased number of re-operations, duration of hospital and ICU stay and incidence of incisional hernias when compared to VAWCM.Keywords
This publication has 29 references indexed in Scilit:
- Management of the Open AbdomenAnnals of Surgery, 2013
- A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic MeshAnnals of Surgery, 2013
- Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral herniaHernia, 2012
- Intraperitoneal Mesh Implantation for Fascial Dehiscence and Open AbdomenWorld Journal of Surgery, 2012
- Delayed Primary Closure of the Septic Open Abdomen with a Dynamic Closure SystemWorld Journal of Surgery, 2011
- Temporary Abdominal Closure: Long-Term OutcomesThe Journal of Trauma and Acute Care Surgery, 2011
- Peritoneal Negative Pressure Therapy Prevents Multiple Organ Injury in a Chronic Porcine Sepsis and Ischemia/Reperfusion ModelShock, 2010
- Outcome of Reconstructive Surgery for Intestinal Fistula in the Open AbdomenAnnals of Surgery, 2008
- Vacuum‐assisted Wound Closure and Mesh‐mediated Fascial Traction—A Novel Technique for Late Closure of the Open AbdomenWorld Journal of Surgery, 2007
- Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?Hernia, 2007