Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single center 8-year experience.

Background: Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure (DPFC) and enteroatmospheric fistula rates. Methods: This was a single academic center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008-2016. Descriptive and univariate analyses were performed. Results: Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54 % (n=22), and 59 % (n=24) had a postoperative peritonitis. Mortality was 29 % (n=12) and in to the ICU were admitted 76 % (n=31) of patients. The median duration of OA was seven days with a median of two dressing changes. DPFC rate among survivors was 92 % (n=33) and EAF[spacing acute]s developed in 7 % (n=3). In a subgroup analysis patients with OA in the primary laparotomy for peritonitis (n=27) were compared to patients with OA in the subsequent laparotomies (n=14). There were no significant differences between groups. Conclusions: VAWCM in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulae. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk for a need of OA later. Level of evidence: Observational study, level III (C) 2017 Lippincott Williams & Wilkins, Inc.

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