Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history

Steffi Karhof, Mark Haverkort, Rogier Simmermacher, Falco Hietbrink, Luke Leenen, Karlijn van Wessem

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Abstract

INTRODUCTION: Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment.

METHODS: A retrospective review of all patients that underwent midline laparotomy between January 2008 and December 2012 was performed. Both factors predicting open abdominal treatment and possibility to close the fascia afterwards were identified and analyzed by univariate and multivariate analyses.

RESULTS: 775 laparotomies in 525 patients (60% male) were included. 109 patients (21%) had an open abdomen with a mortality rate of 27%. Male gender and acidosis were associated with open abdominal treatment. In 54%, the open abdomen could be closed by delayed fascial closure. The number of laparotomies both before and during temporary abdominal treatment was associated with failure of closure.

CONCLUSION: In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures. Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.

Original languageEnglish
Pages (from-to)113-120
Number of pages8
JournalEuropean Journal of Trauma and Emergency Surgery
Volume47
Issue number1
Early online date26 Aug 2019
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Delayed fascial closure
  • Open abdomen
  • Open abdominal treatment
  • Temporary abdominal closure

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