What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis.

Background: The open abdomen technique may be used in critically ill patients in order to manage abdominal injury, reduce the septic complications and prevent the abdominal compartment syndrome. Many different techniques have been proposed and multiple studies have been conducted, but the best method of temporary abdominal closure has not been determined yet. Recently, new randomized and non-randomized controlled trials have been published on this topic. We aimed to perform an up-to-date systematic review on the management of open abdomen including the most recent published randomized and non-randomized controlled trials, in order to compare NPWT vs no NPWT and define better if one technique has better outcomes than the other, in terms of primary fascial closure, post-operative 30-days mortality and morbidity, entero-atmospheric fistulae, abdominal abscess, bleeding and length of stay. Methods: According to the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, an online literature research (until July 1st 2015) was performed on MEDLINE, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Library databases. The MeSH terms and free words used 'vacuum assisted closure' 'vac;', "open abdomen", "damage control surgery" and "temporary abdominal closure". No language restriction was made. Results: The initial systematic literature search yielded 452 studies. After careful assessment of the titles and of the full text was obtained 8 articles fulfilled inclusion criteria. We analysed 1225 patients, 723 (59%) of whom underwent NPWT and 502 (41%) who underwent no NPWT, and performed four subgroups: VAC vs Bogota bag technique (two studies, 106 participants), VAC vs Mesh-foil laparostomy (two studies, 159 participants), VAC vs laparostomy (adhesive impermeable with midline zip) (one study, 106 participants) and NPWT vs No NPWT techniques (three studies, 854 participants) in which it is not possible perform an analysis of the different type of treatments. Comparing the NPWT group and the group without NPWT, there was no statistically significant difference in fascial closure (63.5% vs 69.5%, OR = 0.74, 95% CIs [0.27, 2.06], p = 0.57), post-operative 30-days overall morbidity (p=.19), post-operative entero-atmospheric fistulae rate (2.1% vs 5.8%, (OR = 0.63, 95% CIs [0.12, 3.15], p = .57), in the post-operative bleeding rate (5.7% vs 14.9%, OR = 0.58, 95% CIs [0.05, 6.84], (p = .87) and post-operative abdominal abscess rate (2.4% vs 5.6%, OR = 0.42, 95% CIs [0.13, 1.34] p=.14). On the other hand, statistical significance was found between the NPWT group and the group without NPWT in the post-operative mortality rate (28.5% vs 41.4%, OR = 0.46, 95% CIs [0.23, 0.91] p = .03) and in the length of stay in ICU (mean difference = -4.53, 95% CIs [-5.46, 3.60]), p

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