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Comparative study of abdominal cavity temporary closure techniques for damage control.

Marcelo A F Ribeiro1, Emily Alves Barros1, Sabrina Marques DE Carvalho1

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Damage control surgery can lead to ventral incisional hernias. This review compares Vacuum-Assisted Closure Therapy (VAC), Bogotá Bag, and Vacuum-pack for temporary abdominal closure, finding VAC most effective for primary closure despite higher costs.

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Area of Science:

  • Abdominal Surgery
  • Surgical Techniques
  • Wound Management

Background:

  • Damage control surgery and laparostomy often cause aponeurosis shrinkage, hindering abdominal wall closure and leading to ventral incisional hernias.
  • Temporary abdominal closure techniques are crucial for managing the abdominal wall after damage control surgery.
  • Existing methods aim to improve the chances of abdominal cavity closure with reduced tension.

Purpose of the Study:

  • To evaluate and compare three temporary abdominal cavity closure techniques: Vacuum-Assisted Closure Therapy (VAC), Bogotá Bag, and Vacuum-pack.
  • To assess the efficacy and practicality of each method in preventing incisional hernias post-damage control surgery.

Main Methods:

  • A systematic literature review was conducted.
  • Twenty-eight relevant articles published within the last 20 years were selected and analyzed.
  • The study compared the outcomes, costs, and accessibility of VAC, Bogotá Bag, and Vacuum-pack techniques.

Main Results:

  • Bogotá Bag and Vacuum-pack offer advantages in material accessibility and lower costs across various centers.
  • Vacuum-Assisted Closure Therapy (VAC) presents higher costs and limited availability in many hospitals.
  • VAC demonstrated superior effectiveness in reducing wound edge tension, managing fluid/waste, and promoting cellular proliferation, resulting in the highest rates of primary abdominal cavity closure.

Conclusions:

  • While Bogotá Bag and Vacuum-pack are cost-effective and accessible options, VAC shows superior clinical outcomes in terms of primary closure rates and wound healing.
  • The choice of technique should consider a balance between cost, availability, and the desired clinical outcome for preventing ventral incisional hernias.
  • Further research may explore optimizing VAC or developing more accessible alternatives with similar efficacy.