Protocol Improves Open Abdominal Closure
Major Finding: Primary fascial closure was achieved in all 29 patients in whom the protocol was followed versus 55% of 22 patients in whom it was not followed.
Data Source: Prospective observational study of 51 patients with open abdomens.
Disclosures: Dr. Burlew and her coinvestigators reported no relevant financial disclosures. Dr. Lopez also reported having no financial conflicts.
FROM THE ANNUAL MEETING OF THE WESTERN SURGICAL ASSOCIATION
"I think this shows that the protocol does make a difference. ... This is really what we feel is the best way to accomplish closure in very complex patients. One patient had a [superior mesenteric vein] transection and you can only imagine the bowel edema associated with that patient, and we were still able to get that patient closed by 3 weeks," she said.
Dr. Lopez also asked whether the lack of bowel evisceration may have contributed to the low fistula rate. Dr. Burlew explained that the VAC sponges and fascial sutures are exchanged without evisceration of the bowel because manipulation of the suture lines or marked movement of enteral access sites could cause injury with fistula formation. For this reason, gastrostomy and jejunostomy tubes are also not placed until well into the sequential closure technique, with nasojejunal access an alternative option. Only in patients with increasing white counts or unexplained fever is the abdomen explored, with culture of the abdominal fluid performed regardless of the appearance of the abdomen, she said.
Dr. Burlew and her coinvestigators reported no relevant financial disclosures. Dr. Lopez also reported having no financial conflicts.
