W. Abosena1, M. Bawazeer1, M. Antoine Fortin2, J. Rezende-Neto2, A. Tedesco1, S. Han1, H. Hojman1, B. Johnson1, M. Velez1, W. Cho Kim1, N. Bugaev1 1Tufts Medical Center, Division Of Emergency Surgical Services , Tufts University School Of Medicine Department Of Surgery, Boston, MA, USA 2St. Michael Hospital, Division Of Emergency Surgical Services, Department Of Surgery, University Of Toronto, Toronto, ONTARIO, Canada
Introduction:
Leaving patients with an open abdomen (OA) after damage control surgery is a common approach for managing intra-abdominal catastrophes. The selected method of temporary abdominal closure may affect the ability and time to achieve primary fascial closure. This study aimed to compare the primary fascial closure rate using the Wittmann patch versus the non-invasive Abdominal fascia Closure Device (AbCLo).
Methods:
A retrospective analysis was conducted including trauma and emergency general surgery patients who underwent damage control laparotomy at two level 1 trauma centers in the US and Canada from 2017-2022. Demographics and clinical data from patients who underwent temporary abdominal closure with Wittmann patch (applied in the operating room) and AbCLo were recorded. AbClo devices were applied at the bedside without any surgical procedure. The primary outcomes measure were the rate and time to primary fascial closure.
Results:
77 patients (29 (38%) trauma and 48 (62%) emergency general surgery) were included. 49 (63%) patients were managed using the Wittmann patch and 28 (37%) patients were managed with the AbCLo device. Demographics did not differ significantly between the two groups. The primary fascial closure rate with Wittmann patch (83.6%) did not differ significantly from AbCLo group (85.7%) (p = 0.4). Successful fascial closure took longer in the Wittmann patch (6.4 days ± 5.1 days) compared to the AbCLo group (3.7 days ± 2.1 days) (p = 0.0015), and more trips to the operating room prior to fascial closure (mean trips Wittmann Patch 2.4 ±1.7 vs. AbCLo 1.8 ±1, p= 0.04).
Conclusion:
In patients with an open abdomen after damage control surgery, both the Wittmann Patch and the non-invasive Abdominal fascia Closure device can achieve a high rate of primary fascial closure, reducing the need for future abdominal wall reconstruction. The time and number of operations required to achieve fascial closure appear to be lower with the AbCLo device.
