title: One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction.
abstract: BACKGROUND
  Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure.
  
  
  METHODS
  A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted.
  
  
  RESULTS
  The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia.
  
  
  CONCLUSIONS
  Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past.
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden. thordur.bjarnason@skane.se
authors.forename: Thordur
authors.initials: T
authors.lastname: Bjarnason
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
authors.forename: O
authors.initials: O
authors.lastname: Ekberg
authors.forename: S
authors.initials: S
authors.lastname: Acosta
authors.forename: M
authors.initials: M
authors.lastname: Svensson
authors.forename: A
authors.initials: A
authors.lastname: Wanhainen
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.forename: U
authors.initials: U
authors.lastname: Petersson
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000368:Aged; D003125:Colostomy; D015897:Comorbidity; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D007081:Ileostomy; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013526:Surgical Mesh