title: Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen.
abstract: BACKGROUND
  This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This "open abdomen" must then be temporarily closed. However, the FC rate varies between techniques.
  
  
  METHODS
  The Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) "open abdomen," "fascial closure," "vacuum," "reapproximation," and "ventral hernia." Open abdomen was defined as "the inability to close the abdominal fascia after laparotomy." Two reviewers independently extracted data from original articles by using a predefined checklist.
  
  
  RESULTS
  The search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%).
  
  
  CONCLUSIONS
  These results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rates.
authors.affiliation: Department of Surgery, Academic Medical Center, P.O. Box 22660, Room G4-150, 1100 DD, Amsterdam, The Netherlands. p.boelevanhensbroek@amc.uva.nl
authors.forename: Pieter
authors.initials: P
authors.lastname: Boele van Hensbroek
authors.forename: Jan
authors.initials: J
authors.lastname: Wind
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.forename: J
authors.initials: J
authors.lastname: Carel Goslings
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery*; D003161:Compartment Syndromes / Q000601:surgery; D000071938:Fasciotomy; D006555:Hernia, Ventral / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D014618:Vacuum