title: Management of open abdomen with an absorbable mesh closure.
abstract: OBJECTIVE
  To examine the methods and results of treatment in patients with an open abdomen (OA) at a single institution where an absorbable mesh closure (AMC) is most commonly used.
  
  
  METHODS
  A retrospective study was performed in OA patients from January 2001 to June 2007. Outcomes were analyzed in terms of enteroatmospheric fistula (EAF) formation and survival.
  
  
  RESULTS
  There were 73 OA patients receiving definitive closures (40 trauma and 33 nontrauma). Twenty-four patients were able to undergo a delayed primary fascial closure (DPFC) after initial vacuum pack closure (DPFC rate 33%). The DPFC rate was significantly lower in patients with an associated infection or contamination (9% vs 44%, P = 0.002). The EAF and mortality rates of the DPFC group were 0% and 13%, respectively. Absorbable mesh closure was used in 41 of 49 patients who failed DPFC (84%). There were 9 patients who had EAF (overall EAF rate 12%), 6 of whom were in the AMC group (EAF rate 15%). The overall and AMC group mortality rates were 29% and 37%, respectively.
  
  
  CONCLUSIONS
  Absorbable mesh closure carries high EAF and mortality rates. Therefore, DPFC should be considered as the primary closure method. Absorbable mesh closure should be reserved for patients who fail DPFC, especially those with peritonitis or contamination.
authors.affiliation: Department of Surgery, Chulalongkorn University, Rama4 Road, Bangkok, Thailand.
authors.forename: Supparerk
authors.initials: S
authors.lastname: Prichayudh
authors.forename: Suvit
authors.initials: S
authors.lastname: Sriussadaporn
authors.forename: Pasurachate
authors.initials: P
authors.lastname: Samorn
authors.forename: Rattaplee
authors.initials: R
authors.lastname: Pak-Art
authors.forename: Sukanya
authors.initials: S
authors.lastname: Sriussadaporn
authors.forename: Kritaya
authors.initials: K
authors.lastname: Kritayakirana
authors.forename: Allan
authors.initials: A
authors.lastname: Capin
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery; D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000071938:Fasciotomy; D006801:Humans; D008875:Middle Aged; D011098:Polyglactin 910 / Q000627:therapeutic use*; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011100:Polyglycolic Acid; D011098:Polyglactin 910