[Fascial abdominal closure is a key factor of effective VAC-assisted laparostomy]
A A Shchegolev1,2, R S Tovmasyan1,2, A E Markarov2
1Pirogov Russian National Research Medical University, Moscow, Russia.
Objective:
To evaluate the efficiency of various methods of primary fascial abdominal closure in VAC-laparostomy.
Material And Methods:
The study included 94 patients with traumatic and non-traumatic abdominal disasters. Treatment strategy of «open abdomen» (OA) was used. The following methods of fascial closure (FC) were used: primary fascial suturing (PFS) and various options for vacuum-assisted closure (VAC) including options without alloplasty (VAC-suturing) and with abdominal wall alloplasty (VAC-alloplasty).
Results:
The overall mortality was 34% (32 patients). Of these, 26 ones died before FC (27.7% of total number of patients and 81.2% of total number of deaths), and 6 patients after FC onset (6.4% of total number of patients and 18.8% of total number of deaths). Attempts of FC were made in 68 patients. Successful FC was performed in 45 patients (66.2% of all attempts).
Conclusion:
The best results were achieved after VAC-alloplasty (IPOM in-lay). FC through VAC-alloplasty with OA strategy significantly improves the results of treatment.
