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Langenbecks Arch Surg. 2019 Jun;404(4):489-494. doi: 10.1007/s00423-019-01757-2. Epub 2019 Feb 7.

Blurring the boundary between open abdomen treatment and ventral hernia repair.

Author information

1
Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland. sakaeser@swissonline.ch.
2
Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland.

Abstract

PURPOSE:

Therapeutic approaches for septic open abdomen treatment remain a major challenge with many uncertainties. The most convincing method is vacuum-assisted wound closure with mesh-mediated fascia traction with a protective plastic sheet placed on the viscera. As this plastic sheet and the mesh must be removed before final fascial closure, such a technique only allows temporary abdominal closure. This retrospective study analyzes the results of a modification of this technique allowing final abdominal closure using an anti-adhesive permeable polyvinylidene fluoride (PVDF) mesh.

METHODS:

The outcome of all consecutive patients with septic open abdomen treatment at one academic surgical department from January 2013 to June 2015 was retrospectively analyzed.

RESULTS:

Retrospectively, 57 severely ill consecutive patients with septic open abdomen treatment with a 30-day mortality of 26% and a 2-year mortality of 51% were included in the study. In 26 patients, no mesh was implanted; in 31 patients, mesh implantation was done at median third-look laparotomy, median 5 days postoperative. Re-laparotomies after mesh implantation (median n = 2) revealed anastomotic leakage in 16% but no new bowel fistula. In 40% of those patients who had mesh implantation, fascia closure was not achieved and the mesh was left in place in a bridging position avoiding planned ventral hernia.

CONCLUSION:

The application of an anti-adhesive PVDF mesh for fascia traction in vacuum-assisted wound closure of septic open abdomen is novel, versatile, and seems to be safe. It offers the highly relevant possibility for provisional and final abdominal closure.

KEYWORDS:

Abdominal sepsis; Bridging mesh; Mesh-mediated fascia traction; Open abdomen treatment; Vacuum-assisted wound closure

PMID:
30729317
DOI:
10.1007/s00423-019-01757-2

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