The open abdomen and temporary abdominal closure systems - historical evolution and systematic review

Aim Several techniques for temporary abdominal closurehave been developed. We systematically review theliterature on temporary abdominal closure to ascertainwhether the method can be tailored to the indication.Method Medline,Embase,theCochraneCentralRegisterof Controlled Trials and relevant meeting abstracts untilDecember 2009 were searched using the following head-ings: open abdomen, laparostomy, VAC (vacuum assistedclosure), TNP (topical negative pressure), fascial closure,temporary abdominal closure, fascial dehiscence and deepwound dehiscence. The data were analysed by closuretechniqueandaetiology.Theprimaryend-pointsincludeddelayed fascial closure and in-hospital mortality. The sec-ondary end-points were intra-abdominal complications.Results The search identified 106 papers for inclusion.The techniques described were VAC (38 series), mesh ⁄sheet (30 series), packing (15 series), Wittmann patch(eight series), Bogota´ bag (six series), dynamic retentionsutures (three series), zipper (15 series), skin only andlocking device (one series each). The highest facialclosure rates were seen with the Wittmann patch (78%),dynamic retention sutures (71%) and VAC (61%).Conclusion Temporary abdominal closure has evolvedfrom simple packing to VAC based systems. In theabsence of sepsis Wittmann patch and VAC offered thebest outcome. In its presence VAC had the highestdelayed primary closure and the lowest mortality rates.However, due to data heterogeneity only limited con-clusions can be drawn from this analysis.Keywords Open abdomen, laparostomy, historical evo-lution, systematic review