Facilitated Delayed Closure of Open Abdomen in Septic Patients Combining Negative Pressure Assisted Closure (NPAC) with a Dynamic Fascial Suture (DFS)

Rene H Fortelny, MD, Alexander H Petter-Puchner, MD, Simone Gruber-Blum, MD, Andreas Gaderer, MD, Karl S Glaser, MD

Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna Austria

Introduction: The aim of this prospective controlled trial is to define the optimal timepoint for delayed closure after negative pressure assisted closure in the treatment of the open abdomen in septic patients after abdominal surgery.

The delayed closure of the abdominal wall after abdominal NPAC treatment is currently a problem due to the high tension of sutures due to the lateralisation of the edges of the fascia. We present early results of an innovative combination of NPAC with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.

Methods: During the first surgical procedure using NPAC-technique the fascia in the midline are approximated with a running suture of elastic vessel loop. At final closure the abdomen can be closed in the midline using a running nonresorbable suture and in some cases in combination with a anterior component separation.

Results: 89 patients suffering from an open abdomen following surgery for secondary peritonitis were treated with NPAC and DFS. Delayed closure was achieved in 66 patients (74%) after 9,3 (1-63) days and 4 (1-42) number of revisions. Mortality rate was 28%. 8 superficial and 2 deep wound infection occurred. In 3 cases enteroatmospheric fistulas had to be treated . We recorded no technique-specific complication. 3 incisional hernia were detected in a follow up of 22,9 (1-53) month.

Discussion: Using a new technique combining NPAC and DFS in the treatment of the OA, the delayed wound closure by tension-less running suture of the fascia can be achieved easily with low risk of bursting abdominal walls and incisional hernias.

Session: Podium Presentation

Program Number: S022

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