[Abdominal vacuum device with open abdomen].
BACKGROUND
For the treatment of peritonitis or abdominal compartment syndrome, an open abdomen can be required. Because of the high complication rate associated with this method, different technical modifications were developed that are now being applied. Abdominal vacuum-assisted closure is increasingly favoured. We analyse our experience with this device in a distinct group of patients from gastrointestinal cancer surgery.


METHODS
From June 2003 to December 2005, 36 patients were treated with 151 double-layer abdominal vacuum devices. Indications for applying this device were peritonitis (n = 22), abdominal compartment syndrome (n = 11), and necrotising fasciitis (n = 3). Thirty-four patients gave anamneses of malignoma.


RESULTS
Overall, the vacuum therapy treatment lasted a median of 13 days (range 3-48). With it, four enteric fistulas (11%) and four abdominal wall bleedings (11%) occurred. In our patient group, no new intra-abdominal abscesses were observed. Four patients died during treatment with the vacuum-assisted device and four afterward because of multiple organ failure in acute sepsis (in-hospital mortality 22%). Twenty-six patients (72%) underwent direct fascial closure after a median treatment duration of 10 days. Six patients (17%) required synthetic mesh for fascial closure. After a median follow-up of 100 days, two patients developed ventral hernias and two others showed ossification of the scar.


CONCLUSIONS
Compared with other methods of temporary abdominal closure, our experience with the vacuum-assisted device demonstrates its advantages concerning clinical feasibility and the relatively low complication rate. The high rate of direct fascial closure with an acceptable rate of ventral hernias following vacuum-assisted abdominal closure are further benefits of this technique.
Oetting
P
P
Klinik für Chirurgie und Chirurgische Onkologie, Universitätsmedizin Berlin, Charité Campus Buch, Robert-Rössle-Klinik im Helios-Klinikum Berlin, Lindenberger Weg 80, Berlin.
Rau
B
B
Schlag
P M
PM
D000005:Abdomen / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003161:Compartment Syndromes / Q000601:surgery*; D019115:Fasciitis, Necrotizing / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009779:Occlusive Dressings; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications; D013526:Surgical Mesh; D013997:Time Factors; D014618:Vacuum