Vacuum-Assisted Closure Therapy in Patients Undergoing Liver Transplantation With Necessity to Maintain Open Abdomen.
BACKGROUND
Negative-pressure wound therapy (NPWT) has been recognized as a valid method of temporary abdominal closure. The role of open abdomen (OA) in the management of abdominal sepsis has been a controversial issue. Recent experimental and clinical studies have indicated that vacuum-assisted closure (VAC) is associated with superior outcomes in the treatment of OA conditions, but sufficient proof of efficacy and effectiveness is lacking.


METHODS
We enrolled in this observational study all patients who had undergone liver transplantation (LT) for all causes between 2007 and 2014 in whom we needed to use VAC therapy, describing the pathology that led to the complication, length of hospitalization, graft survival, microbial identifications, and causes of death.


RESULTS
We enrolled 11 patients-6 men (55%) and 5 women (45%), from 41.92 to 64.96 years old (mean, 57.62 ± 6.56 years) -who went to LT for different pathologies. The mean hospital stay was 56.72 ± 36.40 days (range, 8-133 days). Graft survival was 35.65 ± 31.61 months (range, 1.51-89.19 months). Six of 11 patients died (55%) of different causes; in particular, 4 patients died 1 to 3 months after the procedures that led to the condition of OA for septic shock and subsequent multi-organ failure.


CONCLUSIONS
Complications related to the use of NPWT, such as painful management and bleeding, are rare and mild when the device is used properly. Although studies are needed to verify the real cost/benefit ratio in this application of VAC therapy, we consider it a useful means to treat the OA condition.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
G
G
Assirati
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
V
V
Serra
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
G
G
Tarantino
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
S
S
Aldrovandi
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
R
R
Ballarin
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
P
P
Magistri
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
N
N
De Ruvo
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: fabrizio.dibenedetto@unimore.it.
F
F
Di Benedetto
D000005:Abdomen; D000328:Adult; D001658:Biliary Fistula / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000628:therapy*; D007902:Length of Stay; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000628:therapy*; D013530:Surgical Wound Infection / Q000628:therapy*; D058106:Wound Closure Techniques