title: Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis.
abstract: Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included "open abdomen," "abdominal compartment syndrome," "laparostomy," "celiotomy," "abdominal closure," "primary," "delayed," "permanent," "fascial closure," and "definitive closure." Open abdomen was defined as "fail to close abdominal fascia after a laparotomy." Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China ; Minimally Invasive Department of General Surgery, Fushun Central Hospital, Fushun, Liaoning 113006, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal-Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China.
authors.forename: Jinning
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Gastrointestinal-Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Gastrointestinal-Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal-Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China.
authors.forename: Yujie
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Jianan
authors.initials: J
authors.lastname: Ren