Dr Pieter Boele and colleagues from the Netherlands systematically reviewed the literature to assess which temporary abdominal closure technique is associated with the highest delayed primary fascial closure rate.
In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy.
This ‘open abdomen’ must then be temporarily closed.
However, the fascial closure rate varies between techniques.
The team searched the Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases until December 2007.
References were checked for additional studies.
|Artificial burr and the vacuum-assisted closure are associated with the lowest mortality rates|
|World Journal of Surgery|
Open abdomen was defined as ‘the inability to close the abdominal fascia after laparotomy‘.
The team reported that 2 reviewers independently extracted data from original articles by using a predefined checklist.
The researchers found 154 abstracts of which 96 were considered relevant, and 57 case series were identified.
No comparative studies were identified.
The techniques described were vacuum-assisted closure, vacuum pack, artificial burr, Mesh/sheet, zipper, silo, skin closure, dynamic retention sutures, and loose packing.
The team observed the highest fascial closure rates with the artificial burr, dynamic retention sutures, and vacuum-assisted closure.
The lowest mortality rates were seen with the artificial burr, vacuum-assisted closure, and dynamic retention sutures.
Dr Boele’s team concluded, “These results suggest that the artificial burr and the vacuum-assisted closure are associated with the highest fascial closure rates, and the lowest mortality rates.”