Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis.
BACKGROUND
Open abdomen treatment because of severe abdominal sepsis and abdominal compartment syndrome remains a difficult task. Different surgical techniques are available and are often used according to the surgeon's personal experience. Recently, the abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. In this study, we evaluate the role of this treatment option.


METHODS
This prospective observational cohort study includes 37 consecutive patients who were temporarily treated with VAC for severe abdominal sepsis or abdominal compartment syndrome, or both. Patients with abdominal trauma were excluded from the study. Thirty-seven patients undergoing major elective laparotomy and primary abdominal closure served as control group. Primary end points were fascial closure rate, physicoemotional recovery, and appearance outcomes 1 year after closure. Secondary end points included mortality, duration of open abdomen, length of ICU stay, and hospitalization time.


RESULTS
Abdomens were left open for 23 days (range 3 to 122 days) with 3.8 dressing changes (range 1 to 22) per patient. Abdominal closure was achieved in 70% (n = 26), with no marked relation to duration of open abdomen treatment (p > 0.05). After 3 months, patients with VAC treatment recovered to a physical and mental health status similar to patients in the control group (p > 0.05). This status remained stable until the end of the study. Aesthetic outcomes (according to the Vancouver Scar Scale) were considerably poorer in the VAC group compared with controls (p < 0.01).


CONCLUSIONS
Treatment of laparostomy with VAC for abdominal sepsis and abdominal compartment syndrome results in a high rate of successful abdominal closure. In addition, patients recover more rapidly, although hypertrophic scars might interfere with body perception. We recommend abdominal VAC system as first option if open abdomen treatment is indicated.
Perez
Daniel
D
Department of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
Wildi
Stefan
S
Demartines
Nicolas
N
Bramkamp
Matthias
M
Koehler
Christian
C
Clavien
Pierre-Alain
PA
D000005:Abdomen; D034841:Abdominal Cavity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003161:Compartment Syndromes / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D010538:Peritonitis / Q000601:surgery; D011446:Prospective Studies; D018805:Sepsis / Q000601:surgery*; D014618:Vacuum