title: Open abdomen treatment after aortic aneurysm repair with vacuum-assisted wound closure and mesh-mediated fascial traction.
abstract: OBJECTIVE
  Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.
  
  
  METHODS
  All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated <5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.
  
  
  RESULTS
  Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA. Eighteen (60%) were operated on for rupture and 12 (40%) electively. Eight had suprarenal or thoraco-abdominal aneurysms. Eight (27%) died within 30 days, none due to OA-related complications. Four died before abdominal closure; primary delayed fascial closure was achieved in all survivors. One-year mortality was 50%. Ten (33%) had bowel ischaemia requiring bowel resection. Late potential OA-related infectious complications occurred in five (17%), all of whom first developed intestinal ischaemia: entero-atmospheric fistulae (two), graft infections (two), aorto-enteric fistula (one). One year follow-up with clinical evaluation and CT showed no signs of graft infection. Incisional hernias occurred in 9 of 15 patients (60%); only three were symptomatic.
  
  
  CONCLUSIONS
  VAWCM provided high fascial closure rate after AA repair and long-term OA treatment. Infectious complications occur after intestinal ischaemia and prolonged OA treatment, and are often fatal. The poor prognosis among patients needing OA after AA surgery may be improved by using VAWCM, permitting earlier closure.
authors: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE-751 85 Uppsala, Sweden.
authors: K
authors: K
authors: Sörelius
authors: A
authors: A
authors: Wanhainen
authors: S
authors: S
authors: Acosta
authors: M
authors: M
authors: Svensson
authors: K
authors: K
authors: Djavani-Gidlund
authors: M
authors: M
authors: Björck
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation; D013526:Surgical Mesh; D013548:Sweden; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014143:Traction / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016896:Treatment Outcome