Optimal management of the open abdomen remains controversial.
Dr Amy Vertrees and colleagues from Washington, USA retrospectively reviewed patients injured during Operations Enduring Freedom and Iraqi Freedom returning to the Walter Reed Army Medical Center between 2003 to 2007 for treatment of open abdomen.
The researchers identified 354 patients evacuated to Walter Reed Army Medical Center after laparotomy, including 86 patients with open abdomen.
The team excluded 3 transferred patients.
|Surgical management included early definitive abdominal closure in 67%|
|Journal of the American College of Surgeons|
The team studied 83 patients, with a mean age of 26 years, sustaining injury from secondary blast, gunshot, and blunt trauma.
Surgical management included early definitive abdominal closure in 67%, primary fascial closure in 18%, a planned ventral hernia in 11%, and vacuum-assisted closure with AlloDerm in 4%.
Early definitive abdominal closure involves serial closure with Gore-Tex Dualmesh, and final closure supplemented with polypropylene mesh or AlloDerm.
The research team found that there was no substantial difference in injury mechanism, age, length of evacuation to Walter Reed Army Medical Center, or Injury Severity Score according to closure type.
Complications included removal of infected prosthetic mesh in 5% of early definitive abdominal closure patients.
The team observed that overall morbidity was lowest in primary repair patients, at 60%.
The researchers noted that rates of deep venous thrombosis, pulmonary embolism, abdominal wall hematoma, and infection did not differ between groups.
Fistula rate was increased with planned ventral hernia in 20%.
The team identified 2 patients with planned ventral hernia that died.
Planned ventral hernia and early definitive abdominal closure mesh complications have been minimized in the last 2 years of the study.
Dr Vertrees’ team concluded, “Primary closure of fascia is ideal but not always possible.”
“Early definitive closure has avoided planned ventral hernia.”
“Mesh-related complications have decreased with time.”