Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and...

Area of Science:

• Abdominal surgery
• Trauma surgery
• Critical care medicine

Background:

• Abdominal coverage options post-laparotomy vary, with polyglactin mesh (MESH) and vacuum-assisted closure (VAC) being common choices.
• Patient outcomes and differences between MESH and VAC require further investigation.

Purpose of the Study:

• To compare morbidity and mortality differences between MESH and VAC for abdominal coverage in patients requiring open abdomen management.

Main Methods:

• Prospective randomized trial comparing MESH and VAC in patients expected to survive.
• Patients randomized to MESH or VAC, with specific protocols for device placement, changes, and wound management.
• Both groups received split thickness skin grafting if delayed primary closure was not feasible.

Main Results:

• No significant difference in delayed primary fascial closure rates between VAC (31%) and MESH (26%) groups.
• Fistula rate was higher in the VAC group (21%) compared to the MESH group (5%), though not statistically significant.
• Intra-abdominal infection rates were not statistically different between the groups.

Conclusions:

• MESH and VAC are both effective for abdominal coverage, yielding similar delayed primary closure rates.
• The higher fistula rate in VAC may be linked to feeding tube manipulation; nasojejunal tube feeding is recommended.
• Neither MESH nor VAC impacts the need for secondary abdominal wall reconstruction.