VAC-instillation therapy in abdominal mesh exposure: a novel indication

Defects of the abdominal wall pose a problem for general surgeons that negatively affects patient prognosis. In cases of abdominal wall wound dehiscence and exposed abdominal mesh, conservative treatment has not been proven effective to date. We aimed to study patient outcomes in cases of abdominal wall wound dehiscence with mesh exposure treated with vacuum-assisted closure system with intermittent instillation (VAC-instillation) as a temporary cover to achieve wound closure.

A retrospective cohort study was performed to evaluate and compare the outcomes of 45 patients with postoperative abdominal wall wound dehiscence and exposed mesh: 34 were treated with conventional dressings and 11 with the VAC-instillation device. Clinical records were reviewed, and patient demographics, indication for abdominal surgery, and existing risk factors were noted. Patient outcome was evaluated in terms of number of reoperations, length of hospital stay, and total time of treatment.

Demographic features did not differ significantly between the two groups. Patients treated with conventional dressings required a significantly higher number of surgeries to achieve wound closure. We did not find statistical differences between the two groups regarding length of hospital stay, but the VAC-instillation group showed a significantly shorter total time of treatment. The incidence of complications was lower in the VAC-instillation group, though hernia recurrence rate was slightly higher in these patients.

VAC-instillation is a valid option for the conservative treatment of critical patients with abdominal wall wound dehiscence and exposed infected mesh that allows recovery with fewer surgeries and complications and avoids the need of mesh removal.