Anastomotic Outcomes After Damage Control Laparotomy With Temporary Abdominal Closure

Negative pressure wound therapy (NPWT) is widely utilized to facilitate temporary abdominal closure following damage control laparotomy. The direct role of NPWT on anastomotic leak rates remains unclear. This study evaluates whether anastomotic exposure to NPWT is associated with increased risk for leak.

We performed a retrospective cohort study including all patients who underwent emergent exploratory laparotomy with temporary abdominal closure at our institution from 2013 to 2023. Patients were stratified based on whether or not they were treated with intra-abdominal NPWT applied in the setting of a newly created anastomosis.

Of 225 included patients, 93 (41%) received anastomotic exposure to NPWT. In multivariable regression, anastomotic NPWT exposure was not significantly associated with risk of leak. However, the Physiological Emergency Surgery Acuity Score (odds ratio: 1.359, P = 0.010) and days to fascial closure (odds ratio: 1.274, P < 0.001) were independent predictors of anastomotic leak.

In patients undergoing damage control laparotomy, anastomotic NPWT exposure is not a clear independent risk factor for anastomotic leak and may be judiciously applied to bowel anastomoses when clinically indicated. The risk for leak appears to be more strongly associated with physiologic acuity and illness severity.