Outcomes of Prolonged Open Abdomen in Children
Brianna L Spencer1, Dimitra M Lotakis1, Jessica Carducci2
1Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
Insights
Most children with open abdomens achieved primary closure without mesh, even with multiple surgeries. This study highlights outcomes and suggests a protocolized approach may improve long-term results for pediatric patients.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Reconstruction
- Critical Care
Background:
- Open abdomen management is critical for pediatric patients with instability, requiring resuscitation, or loss of domain.
- Prolonged open abdomen (POA) presents challenges in abdominal wall closure and long-term outcomes.
Purpose of the Study:
- To characterize outcomes in pediatric patients with open abdomens.
- To identify factors influencing successful abdominal wall closure and long-term results.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) from 2015-2022.
- Defined POA as ≥3 surgeries before closure.
- Descriptive statistics used median and interquartile range.
Main Results:
- 93% survival rate in the cohort.
- Most common indication: second look/discontinuity (54%).
- 58% achieved primary tissue closure; others required mesh. POA patients had higher infection rates (56% vs 44%).
Conclusions:
- The majority of pediatric patients with open abdomens can achieve primary closure without mesh.
- Further research should focus on protocolized management to enhance long-term outcomes.
Introduction:
We sought to better characterize outcomes in pediatric patients requiring open abdomen for instability with ongoing resuscitation, second look surgery, or left in discontinuity or congenital or acquired loss of domain that may lead to prolonged open abdomen (POA) or difficulties in successful abdominal wall closure.
Methods:
We performed a single-institution retrospective review of patients aged less or equal to 18 years who presented to our institution from 2015 to 2022. We defined POA as requiring three or more surgeries prior to abdominal wall closure. Descriptive statistics were performed using median and interquartile range.
Results:
Median age was 15 years (interquartile range 0-6 years), 46% female, and 69% White. Survival rate was 93% for the entire cohort. The most common indication for open abdomen was second look/discontinuity 22/41 (54%). The most common temporary abdominal wall closure was wound vac (43%). Fifty eight percent patients achieved primary tissue closure, the remaining required mesh. Of the 42 patients, 25 required POA. They had increasing rate of secondary infections at 56% compared to 44% (P = 0.17). The groups were further divided into indications for open abdomen including ongoing resuscitation, second look/discontinuity, and loss of domain with similar outcomes.
Conclusions:
In the largest series of long-term outcomes in pediatric patients with an open abdomen, we found that a majority of children were able to be primarily closed without mesh despite the number of surgeries required. Further studies require a protocolized approach to improve the long-term outcomes of these patients.
Related Concept Videos
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....