Blurring the boundary between open abdomen treatment and ventral hernia repair

Langenbecks Arch Surg. 2019 Jun;404(4):489-494. doi: 10.1007/s00423-019-01757-2. Epub 2019 Feb 7.

Abstract

Purpose: Therapeutic approaches for septic open abdomen treatment remain a major challenge with many uncertainties. The most convincing method is vacuum-assisted wound closure with mesh-mediated fascia traction with a protective plastic sheet placed on the viscera. As this plastic sheet and the mesh must be removed before final fascial closure, such a technique only allows temporary abdominal closure. This retrospective study analyzes the results of a modification of this technique allowing final abdominal closure using an anti-adhesive permeable polyvinylidene fluoride (PVDF) mesh.

Methods: The outcome of all consecutive patients with septic open abdomen treatment at one academic surgical department from January 2013 to June 2015 was retrospectively analyzed.

Results: Retrospectively, 57 severely ill consecutive patients with septic open abdomen treatment with a 30-day mortality of 26% and a 2-year mortality of 51% were included in the study. In 26 patients, no mesh was implanted; in 31 patients, mesh implantation was done at median third-look laparotomy, median 5 days postoperative. Re-laparotomies after mesh implantation (median n = 2) revealed anastomotic leakage in 16% but no new bowel fistula. In 40% of those patients who had mesh implantation, fascia closure was not achieved and the mesh was left in place in a bridging position avoiding planned ventral hernia.

Conclusion: The application of an anti-adhesive PVDF mesh for fascia traction in vacuum-assisted wound closure of septic open abdomen is novel, versatile, and seems to be safe. It offers the highly relevant possibility for provisional and final abdominal closure.

Keywords: Abdominal sepsis; Bridging mesh; Mesh-mediated fascia traction; Open abdomen treatment; Vacuum-assisted wound closure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hernia, Ventral / mortality
  • Hernia, Ventral / surgery*
  • Herniorrhaphy / methods*
  • Humans
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy*
  • Open Abdomen Techniques*
  • Polyvinyls
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Surgical Mesh
  • Surgical Wound Infection / mortality
  • Surgical Wound Infection / therapy*
  • Suture Techniques

Substances

  • Polyvinyls
  • polyvinylidene fluoride