title: Long-term vacuum-assisted closure in open abdomen due to secondary peritonitis: a retrospective evaluation of a selected group of patients.
abstract: OBJECTIVE
  Vacuum-assisted closure (VAC) leads to a high fascial closure rate in open abdomen within the first week of treatment. However, little data exist on the role of long-term VAC treatment in patients with peritonitis, where fascial closure cannot be accomplished within the first days.
  
  
  METHODS
  We reviewed the medical records of 49 patients with open abdomen for more than 7 days due to secondary peritonitis, who underwent a VAC-treatment. Nonparametric analysis was performed using chi(2) test or Fisher's exact test.
  
  
  RESULTS
  Fascial closure could be accomplished in only 11 patients (22%), whereas complications occurred in 43 patients (88%). Re-explorations after starting VAC were associated with the occurrence of enterocutaneous fistula (p < 0.001) and were also of prognostic value regarding the rate of fascial closure (p = 0.033).
  
  
  CONCLUSIONS
  If fascial closure cannot be accomplished within the first days, patients show a dramatically lower fascial closure and an increased complication rate with VAC. Further studies are needed to evaluate whether this subgroup really benefits from VAC.
authors.affiliation: Department of Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.forename: Ingo
authors.initials: I
authors.lastname: Alldinger
authors.forename: Hanno
authors.initials: H
authors.lastname: Matthaei
authors.forename: Feride
authors.initials: F
authors.lastname: Aydin
authors.forename: Ingo
authors.initials: I
authors.lastname: Wallert
authors.forename: Claus F
authors.initials: CF
authors.lastname: Eisenberger
authors.forename: Jan
authors.initials: J
authors.lastname: Schulte Am Esch
authors.forename: Levent
authors.initials: L
authors.lastname: Dizdar
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Topp
authors.forename: Qin
authors.initials: Q
authors.lastname: Yang
authors.forename: Wolfram T
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001458:Bandages; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D018579:Patient Selection; D010538:Peritonitis / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D013526:Surgical Mesh; D014945:Wound Healing / Q000502:physiology