title: The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications.
abstract: Open abdomen management has become a well-established strategy in the treatment of serious intra-abdominal pathologies. Key objectives are fistula prevention and high fascial closure rates. The current level of evidence on laparostoma is insufficient. This is due to the rareness of laparostomas, the heterogeneity of study cohorts, and broad diversity of techniques. Collecting data in a standardised, multicentre registry is necessary to draw up evidence-based guidelines.
  
  
  
  In order to improve the level of evidence on laparostomy, CAMIN (surgical working group for military and emergency surgery) of DGAV (German Society for General and Visceral Surgery), initiated the implementation of a laparostomy registry. This registry was established as the Open Abdomen Route by EuraHS (European Registry of Abdominal Wall Hernias). Key objectives include collection of data, quality assurance, standardisation of therapeutic concepts and the development of guidelines. Since 1 May 2015, the registry is available as an online database called Open Abdomen Route of EuraHS (European Registry of Abdominal Wall Hernias). It includes 11 categories for data collection, including three scheduled follow-up examinations.
  
  
  
  As part of this pilot study, all entries of the first 120 days were analysed, resulting in a review of 82 patients. At 44%, secondary peritonitis was the predominant indication. The mortality rate was 22%. A comparison of methods with and without fascial traction reveals fascial closure rates of 67% and 25%, respectively (intention-to-treat analysis, p < 0.03). Inert visceral protection was used in 67% of patients and achieved a small bowel fistula incidence of only 5.5%.
  
  
  
  Optimising laparostomy management techniques in order to achieve low incidence of fistulation and high fascial closure rates is possible. The method that ensures the best possible outcome-based on current evidence-would involve fascial traction, visceral protection and negative pressure. The laparostomy registry is a useful tool for quickly generating sufficient evidence for open abdomen treatment.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany. ArnulfWillms@gmx.de.
authors.forename: A
authors.initials: A
authors.lastname: Willms
authors.affiliation: Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs, 30, Ghent, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Muysoms
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Güsgen
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schwab
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Lock
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schaaf
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Germer
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Richardsen
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Dietz
mesh_terms: D000005:Abdomen / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D006555:Hernia, Ventral / Q000517:prevention & control; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012042:Registries
keywords: Abdominal compartement syndrome; Abdominal trauma; Laparostoma; Open abdomen; Peritonitis