Introduction
Technique | Description | Mechanism |
---|---|---|
Vacuum-assisted closure (VAC™) | A perforated plastic sheet covers the viscera and a sponge is placed between the facial edges. The wound is covered by an airtight seal, which is pierced by a suction drain that is connected to a suction pump and fluid collection system. | The (active and adjustable) negative pressure supplied by the pump keeps constant tension on the fascial edges while it collects excess abdominal fluid and helps to resolve edema. |
Vacuum pack | A perforated plastic sheet covers the viscera, damp surgical towels are placed in the wound, and a surgical drain is placed on the towels. An airtight seal covers the wound and negative pressure is applied through the drain. | The negative pressure keeps constant tension on the fascial edges and excess fluid is collected. |
Artificial burr (Wittmann patch) | Two opposite Velcro sheets (hooks and loops, one on each side) are sutured to the fascial edges. The Velcro sheets connect in the middle. | This technique allows for easy access and stepwise reapproximation of the fascial edges. |
Dynamic retention sutures | The viscera are covered with a sheet (e.g., ISODrape™). Horizontal sutures are placed through a large-diameter catheter and through entire abdominal wall on both sides. | The sutures keep tension on the fascia and may be tightened to allow staged reapproximation of the fascial edges. May be combined with a vacuum system. |
Plastic silo (Bogotá bag) | A sterile X-ray film cassette bag or sterile 3-L urology irrigation bag is sutured between the fascial edges or the skin and opened in the middle. | An easy technique that allows for easy access. The bag may be reduced in size to approximate the fascial edges. |
Mesh/sheet | An absorbable or nonabsorbable mesh or sheet is sutured between the fascial edges. Examples are Dexon™ mesh, Marlex™ mesh, and Vicryl™ mesh. Examples of sheets are Silastic™ or silicone sheets. | The mesh or sheet may be reduced in size to allow for reapproximation. Nonresorbable meshes may be removed or left in place at the end of the open abdominal period. |
Loose packing | The fascial defect is covered by standard wound dressing only. | This technique is simple but does not prevent fascial retraction. |
Skin approximation | The skin is closed over the fascial defect with towel clips or a running suture. | Skin provides a “natural cover” for the viscera, but the towel clips obstruct radiological imaging and do not prevent fascial retraction. |
Zipper | A mesh or sheet with a sterilized zipper is sutured between the fascial edges. | This technique is comparable to the mesh/sheet and allows for easy access. |
Materials and methods
Search terms | |
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MeSH | Not used |
Free text words | (Open abdomen OR laparostomy OR open peritoneal cavity OR celiotomy OR open management abdomen OR abdominal wall defect OR open abdominal wound) AND (VAC OR V.A.C. OR vacuum OR closure OR reapproximation OR re-approximation OR fascial closure OR ventral hernia OR temporary abdominal closure OR bogota bag OR fascial dehiscence) |
Field | All fields |
Limits | None |
Study selection and data extraction
Analysis and presentation of data
Results
Included studies
Patients
Temporary closure techniques described
Technique | Author | Year | Inclusion | Group | No. of patients | Mortality (%) | Closure (%) |
---|---|---|---|---|---|---|---|
VAC | Stonerock | 2003 | Retrospective | Tr; Gs | 15 | 7 | 67 |
Miller | 2004 | Prospective | Tr | 53 | 15 | 72 | |
Stone | 2004 | – | Tr | 48 | 33 | 54 | |
Labler | 2005 | – | Tr; ACS; Pt | 18 | 28 | 67 | |
DeFranzo | 2006 | Retrospective | Tr; Pt; CS; Gs; Om | 30 | 10 | 33 | |
Cothren | 2006 | Retrospective | Tr; ACS | 14 | 7 | 100 | |
Oetting | 2006 | – | Pt; ACS; NF | 36 | 22 | 72 | |
Perez | 2007 | Prospective | Pt; ACS | 37 | 38 | 35 | |
Vacuum pack | Brock | 1995 | Retrospective | Mi; RAAA; Pc | 11 | 36 | 18 |
Brock | 1995 | Retrospective | Tr | 17 | 35 | 71 | |
Smith | 1997 | Retrospective | Pc; Mi, CD | 38 | 42 | 55 | |
Sherck | 1998 | Retrospective | Tr; Pt; Mi; Pc; Bl | 50 | 36 | 68 | |
Barker | 2000 | Retrospective | Tr | 112 | 26 | 55 | |
Bosscha | 2000 | Retrospective | Pt | 67 | 42 | 28 | |
Foy | 2003 | Retrospective | Tr; Pt; AAA | 134 | 38 | 47 | |
Navsaria | 2003 | Retrospective | Tr | 55 | 45 | 29 | |
Chavarria-Aguilar | 2004 | Retrospective | Tr | 29 | 10 | 76 | |
Miller | 2005 | Retrospective | Tr | 344 | 20 | 52 | |
Barker | 2007 | Retrospective | GS | 120 | 23 | 61 | |
Barker | 2007 | Retrospective | Va | 22 | 41 | 64 | |
Barker | 2007 | Retrospective | Tr | 116 | 26 | 58 | |
van As | 2007 | – | Tr | 60 | 42 | 27 | |
Wilde | 2007 | Prospective | Pt; Mi; Bl | 11 | 0 | 91 | |
Artificial burr | Aprahamian | 1990 | Prospective | Tr | 20 | 20 | 75 |
Wittmann | 2000 | – | Pt | 128 | 19 | 93 | |
Hadeed | 2007 | Retrospective | Tr | 26 | 8 | 77 | |
Keramati | 2007 | – | ACS | 6 | 67 | 33 |
Technique | Author | Year | Inclusion | Group | No. of patients | Mortality (%) | Closure (%) |
---|---|---|---|---|---|---|---|
Mesh/sheet | Wouters | 1983 | Pt | 20 | 20 | 75 | |
Akers | 1991 | – | Va | 6 | 50 | 67 | |
Smith | 1992 | – | Tr | 5 | 20 | 20 | |
Cohn | 1995 | Retrospective | Tr | 14 | 29 | 64 | |
Fansler | 1995 | Retrospective | Tr; GS; Pc | 26 | 12 | 15 | |
Nagy | 1996 | Retrospective | Tr | 25 | 30 | 40 | |
Yeh | 1996 | Retrospective | Tr | 36 | 28 | 22 | |
Losanoff | 1997 | – | Pt | 19 | 21 | 79 | |
Sugrue | 1998 | Prospective | Tr; Pt; GS; Va | 49 | 43 | 33 | |
Töns | 2000 | – | Tr; Pt, IL; Mi | 377 | 21 | 18 | |
Tremblay | 2001 | Retrospective | Tr; Bl; Pc; Mi | 12 | 33 | 8 | |
Rasmussen | 2002 | Retrospective | AAA | 45 | 56 | 31 | |
Schachtrupp | 2002 | – | Tr; Pt; Mi; ACS | 40 | 20 | 58 | |
Jernigan | 2003 | – | Tr | 274 | 43 | 14 | |
Howdieshell | 2004 | – | Tr | 88 | 19 | 27 | |
Mayberry | 2004 | Retrospective | Tr | 140 | 17 | 31 | |
Zipper | Cuesta | 1991 | Retrospective | Pt | 7 | 29 | 0 |
Bose | 1991 | Retrospective | Pt | 5 | 60 | 20 | |
Hannon | 1992 | – | Pt; Mi | 8 | 0 | 100 | |
Singh | 1993 | – | Pt | 8 | 25 | 38 | |
Hubens | 1994 | – | Pt; NEC; Pc | 23 | 39 | 35 | |
Goor, van | 1997 | Retrospective | Pt; Mi | 24 | 29 | 54 | |
Zingales | 2001 | Retrospective | Pt; Pc; IC; Pi | 60 | 38 | 20 | |
Silo | Doyon | 2001 | Retrospective | Pt | 17 | 18 | 82 |
Tremblay | 2001 | Retrospective | Tr; Bl; Pc; Mi | 75 | 53 | 17 | |
Kushimoto | 2007 | Retrospective | Tr; NT | 17 | 31 | 29 | |
Skin only | Smith | 1992 | – | Tr | 8 | 25 | 75 |
Tremblay | 2001 | Retrospective | Tr; Bl; Pc; Mi | 93 | 40 | 40 | |
Loose packing | Duff | 1981 | Retrospective | Tr; Pt | 18 | 39 | 11 |
Dynamic retention sutures | Koniaris | 2001 | Retrospective | Tr; Pt; IL; AAA; ACS; Pc | 13 | 23 | 85 |
Fascial closure
Fistulae and abscesses
Case series | Patients | Male patients | Age (yr) | Fistulae | Abscesses | Mortality | Closure | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | n | % | (95% CI) | Median | (Range) | % | (95% CI) | % | (95% CI) | n | % | (95% CI) | n | % | (95% CI) | |
VAC | 8 | 251 | 68 | (60–77) | 41 | (35–65) | 2.9 | (0.7–5.1) | 2.6 | (0.2–5) | 56 | 18 | (13–22) | 149 | 60 | (54–66) |
Vacuum pack | 15 | 1186 | 70 | (67–72) | 42.5 | (32–62) | 5.7 | (4.3–7) | 4,1 | (2.9–5.3) | 340 | 27 | (24–29) | 611 | 52 | (49–54) |
Artificial burr | 4 | 180 | 94 | (87–100) | 34 | (30–43) | 2 | (−0.1 to 4.1) | 3.0 | (−1.9 to 7.9) | 34 | 17 | (12–23) | 156 | 90 | (86–95) |
DRS | 1 | 13 | 62 | 50 | NR | NR | 3 | 23 | 11 | 85 | ||||||
Silo | 3 | 109 | 74 | (65–83) | 43.9 | (40–48) | 0 | 6 | 48 | 41 | (32–51) | 32 | 29 | (20–37) | ||
Mesh/sheet | 16 | 1176 | 80 | (78–83) | 37 | (31–75) | 5.5 | (3.6–6.7) | 2.1 | (0.7–3.6) | 334 | 26 | (23–28) | 293 | 23 | (20–25) |
Loose packing | 1 | 18 | NR | NR | 28 | NR | 7 | 39 | 2 | 11 | ||||||
Skin only | 2 | 101 | 90 | (84–96) | 36.1 | (32–40) | NR | NR | 39 | 39 | (29–48) | 43 | 43 | (34–53) | ||
Zipper | 7 | 135 | 72 | (64–80) | 46 | (32–64) | 13.8 | (7.6–20) | 5.8 | (−2.7 to 14.3) | 46 | 33 | (25–41) | 45 | 39 | (31–47) |