Anastomotic Outcomes After Damage Control Laparotomy With Temporary Abdominal Closure

Area of Science:

• Surgical innovation
• Wound management
• Gastrointestinal surgery

Background:

• Negative pressure wound therapy (NPWT) is standard for temporary abdominal closure after damage control laparotomy.
• The impact of NPWT on anastomotic leak rates is not well-defined.
• This study investigates the association between NPWT and anastomotic leaks.

Purpose of the Study:

• To determine if intra-abdominal NPWT exposure increases the risk of anastomotic leak.
• To identify factors predicting anastomotic leak in patients undergoing damage control laparotomy.

Main Methods:

• Retrospective cohort study of 225 patients undergoing emergent exploratory laparotomy with temporary abdominal closure (2013-2023).
• Patients were stratified based on intra-abdominal NPWT application near a new anastomosis.
• Multivariable regression analysis was used to assess predictors of anastomotic leak.

Main Results:

• 93 patients (41%) received NPWT near their anastomosis.
• Anastomotic NPWT exposure was not significantly associated with an increased risk of leak.
• Physiological Emergency Surgery Acuity Score and days to fascial closure were independent predictors of anastomotic leak.

Conclusions:

• Intra-abdominal NPWT is not an independent risk factor for anastomotic leak in damage control laparotomy.
• NPWT can be used judiciously for bowel anastomoses when clinically indicated.
• Anastomotic leak risk is primarily driven by patient physiological status and illness severity.