Managing the open abdomen: negative pressure closure versus mesh-mediated fascial traction closure: a randomized trial

Purpose

To compare the effectiveness of abdominal wall closure using the vacuum-assisted closure (NPC) as described by Barker et al. with an institutional protocol using a double polyvinyl bag in the first surgery, which is changed in subsequent surgeries to a polyvinyl bag placed over the bowel loops and a prolene mesh attached to the abdominal fascia (MMFC).

Methods

Randomized controlled trial. Patients with open abdomen (OA) due to a traumatic or a medical cause were included in the study. Variables studied included demographics, indication for surgery, number of interventions, hospital length of stay (HLOS), ICU length of stay, abdominal wound care costs, complication rates, and method and time to definitive fascial closure.

Results

From June 2011 to April 2013, 75 patients were enrolled in the study. Patients who died within 48 h were excluded; therefore, 53 patients in total were assessed. NPC achieved fascial closure in 75 % of patients, and MMFC achieved closure in 71.9 % of patients. The closure rates in patients with OA secondary to medical causes (80 % by NPC vs. 71.4 % by MMFC) or traumatic causes (70 % by NPC vs. 73.7 % by MMFC) were similar in both treatment groups. There were no differences between the groups with respect to cause of OA, complications, length of hospital stay, or the length of stay in the intensive care unit.

Conclusion

MMFC is a method comparable to NPC for the temporary management of OA that results in similar closure and complication rates.