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Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia.

Dietz UA, Wichelmann C, Wunder C, Kauczok J, Spor L, Strauß A, Wildenauer R, Jurowich C, Germer CT - Hernia (2012)

Bottom Line: Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days.No mesh-related hematomas, seromas, or intestinal fistulas were observed.Long-term course in a large number of patients must still confirm this result.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Gastrointestinal, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. dietz_u@chirurgie.uni-wuerzburg.de

ABSTRACT

Purpose: Once open abdomen therapy has succeeded, the problem of closing the abdominal wall must be addressed. We present a new four-stage procedure involving the application of a two-component mesh and vacuum conditioning for abdominal wall closure of even large defects. The aim is to prevent the development of a giant ventral hernia and the eventual need for the repair of the abdominal wall.

Methods: Nineteen of 62 patients treated by open abdomen over a two-year period could not receive primary abdominal wall closure. To achieve closure in these patients, we applied the following four-stage procedure: stage 1: abdominal damage control and conditioning of the abdominal wall; stage 2: attachment of a tailored two-component mesh of polyglycolic acid (PGA) and large pore polypropylene (PP) in intraperitoneal position (IPOM) plus placement of a vacuum bandage; stage 3: vacuum therapy for 3-4 weeks to allow granulation of the mesh and optimization of dermatotraction; stage 4: final skin suture. During stage 3, eligible patients were weaned from respirator and mobilized.

Results: The abdominal wall gap in the 19 patients ranged in size from 240 cm(2) to more than 900 cm(2). An average of 3.44 vacuum dressing changes over 19 days were required to achieve 60-100 % granulation of the surface area, so final skin suture could be made. Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days. No mesh-related hematomas, seromas, or intestinal fistulas were observed.

Conclusion: The four-stage procedure presented here is a viable option for achieving abdominal wall closure in patients treated with open abdomen, enabling us to avoid the development of planned giant ventral hernias. It has few complications and has the special advantage of allowing mobilization of the patients before final skin closure. Long-term course in a large number of patients must still confirm this result.

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Related in: MedlinePlus

Patient flow diagram
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Fig6: Patient flow diagram

Mentions: In the group of patients with primary abdominal wall closure, the linea alba was sutured with a PDS® 1 USP loop suture or reconstruction was done by implantation of a PP mesh in retromuscular sublay position with the placement of subcutaneous and/or retromuscular suction drainage for 5–6 days. In unfavorable fascial conditions, the rectus sheath layers were closed with bilateral inverted figure-eight sutures [17]. A third patient group was closed in a manner different from that described above (Table 1) (Fig. 6). These were patients with open small bowel fistulas (covered by skin mesh after the granulation of the laparostomy) or who received a secondary skin suture over the bowel convolution without fascia closure.Fig. 6


Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia.

Dietz UA, Wichelmann C, Wunder C, Kauczok J, Spor L, Strauß A, Wildenauer R, Jurowich C, Germer CT - Hernia (2012)

Patient flow diagram
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412951&req=5

Fig6: Patient flow diagram
Mentions: In the group of patients with primary abdominal wall closure, the linea alba was sutured with a PDS® 1 USP loop suture or reconstruction was done by implantation of a PP mesh in retromuscular sublay position with the placement of subcutaneous and/or retromuscular suction drainage for 5–6 days. In unfavorable fascial conditions, the rectus sheath layers were closed with bilateral inverted figure-eight sutures [17]. A third patient group was closed in a manner different from that described above (Table 1) (Fig. 6). These were patients with open small bowel fistulas (covered by skin mesh after the granulation of the laparostomy) or who received a secondary skin suture over the bowel convolution without fascia closure.Fig. 6

Bottom Line: Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days.No mesh-related hematomas, seromas, or intestinal fistulas were observed.Long-term course in a large number of patients must still confirm this result.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Gastrointestinal, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. dietz_u@chirurgie.uni-wuerzburg.de

ABSTRACT

Purpose: Once open abdomen therapy has succeeded, the problem of closing the abdominal wall must be addressed. We present a new four-stage procedure involving the application of a two-component mesh and vacuum conditioning for abdominal wall closure of even large defects. The aim is to prevent the development of a giant ventral hernia and the eventual need for the repair of the abdominal wall.

Methods: Nineteen of 62 patients treated by open abdomen over a two-year period could not receive primary abdominal wall closure. To achieve closure in these patients, we applied the following four-stage procedure: stage 1: abdominal damage control and conditioning of the abdominal wall; stage 2: attachment of a tailored two-component mesh of polyglycolic acid (PGA) and large pore polypropylene (PP) in intraperitoneal position (IPOM) plus placement of a vacuum bandage; stage 3: vacuum therapy for 3-4 weeks to allow granulation of the mesh and optimization of dermatotraction; stage 4: final skin suture. During stage 3, eligible patients were weaned from respirator and mobilized.

Results: The abdominal wall gap in the 19 patients ranged in size from 240 cm(2) to more than 900 cm(2). An average of 3.44 vacuum dressing changes over 19 days were required to achieve 60-100 % granulation of the surface area, so final skin suture could be made. Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days. No mesh-related hematomas, seromas, or intestinal fistulas were observed.

Conclusion: The four-stage procedure presented here is a viable option for achieving abdominal wall closure in patients treated with open abdomen, enabling us to avoid the development of planned giant ventral hernias. It has few complications and has the special advantage of allowing mobilization of the patients before final skin closure. Long-term course in a large number of patients must still confirm this result.

Show MeSH
Related in: MedlinePlus