Temporary abdominal closure: long-term outcomes
Nirav Y Patel1, Thomas H Cogbill, Kara J Kallies
1Department of General and Vascular Surgery, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA. nypatel@gundluth.org
Background:
Temporary abdominal closure (TAC) is an invaluable tool in the armamentarium of surgeons caring for critically ill and injured patients. The objective of this study was to determine the incidence of abdominal wall hernias and intestinal obstructions in patients who underwent TAC.
Methods:
A retrospective review of the medical records of patients who underwent TAC from September 2000 to December 2007 was completed. Patients were stratified by technique and indication for TAC. Statistical analysis included analysis of variance, χ(2), Fisher's exact test, Wilcoxon rank sum test, Kruskal-Wallis test, and Kaplan-Meier analysis.
Results:
One hundred seventeen patients underwent TAC during the study period. Nine patients were excluded from the analysis. For the remaining 108 patients, 30-day mortality was 17%. Definitive fascial closure was accomplished in 91% of patients. Median time to closure was 3 days. Seventy-six (70%) patients survived ≥6 months after definitive fascial or skin-only closure. Median follow-up was 34.5 months. Intestinal obstructions developed in 11% of patients. Abdominal wall hernias developed in 30% of patients with definitive fascial closure. No differences were observed for rates of abdominal wall hernias or intestinal obstructions based on preoperative body mass index, TAC indication, or TAC technique (temporary skin, bridge, or vacuum-assisted device closure).
Conclusion:
Successful definitive fascial closure was achieved in 91% of patients after TAC. Abdominal wall hernias and intestinal obstructions were associated with longer median time to closure and increased ventilator days. No associations with indications for TAC, temporary closure techniques, or definitive closure methods were demonstrated.