Q. TAO1, J. Ren2, B. Wang1, Y. Zheng1, J. Li2 1Affiliated Zhongda Hospital, Southeast University,General Surgery,Nanjing, JIANGSU, China 2Jinling Hospital, Nanjing University,General Surgery,Nanjing, JIANGSU, China
Introduction: Management of open abdomen (OA) is a formidable challenge, certainly when abdominal sepsis is present. Failure to achieve delayed primary fascial closure is one of the most common complications. This prospective cohort study aims to explore the influence of continuous topical irrigation on the management of open septic abdomen.
Methods: The patients with abdominal sepsis who underwent OA using vacuum-assisted and mesh-mediated fascial traction (VAWCM) technique, were divided into the irrigation and control groups. The delayed primary fascial closure rate and other outcomes were compared between the two groups.
Results:Between 2007 and 2013, 73 patients with open septic abdomen were treated with continuous topical irrigation and VAWCM, and 61 cases with only VAWCM. The overall delayed primary fascial closure rate in the irrigation group was significantly increased (63% vs 41%, p = 0.011). The mortality with OA was similar (24.6% vs 23%, p = 0.817). However, time to delayed primary fascial closure (p = 0.003) and length of stay in hospital (p = 0.022) in the survivals were significantly decreased in the irrigation group. In addition to topical irrigation (OR 1.453, 95% CI 1.222 – 4.927, p = 0.011), early enteral feeding (OR 3.357, 95% CI 1.479 – 7.619; p = 0.003) and restricted crystalloid fluid infusion (OR 2.611, 95% CI 1.296 – 5.261; p = 0.007) were independent influencing factors related to successful fascial closure of open septic abdomen.
Conclusion:Continuous topical irrigation could improve the delayed primary fascial closure, but could not decrease the mortality in the patients with open septic abdomen using VAWCM method. Early enteral feeding and restricted crystalloid fluid infusion might be recommended in such population.