Ulus Travma Acil Cerrahi Derg. 2018; 24(4): 321-326 | DOI: 10.5505/tjtes.2017.95038

Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen

Erol Kiliç, Mustafa Uður, Ýbrahim Yetim, Muhyittin Temiz
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum- Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated.
METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013–2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared.
RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05).
CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality
rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

Keywords: Baker method, Bogota bag, Non-vacuum assisted closure method (NVACM); open abdomen; temporary abdomen closure; acuum-Assisted Closure Method (VACM).

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Açýk karýn (open abdomen) uygulanan hastalarda geçici karýn kapama yöntemlerinin mortalite ve morbidite üzerine etkisi

Erol Kiliç, Mustafa Uður, Ýbrahim Yetim, Muhyittin Temiz
Mustafa Kemal Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Hatay

AMAÇ: Ciddi abdominal sepsis ve abdominal kompartman sendromu geliþen hastalarda günümüzde uygulanan en önemli tedavi yöntemi abdomenin geçici karýn kapama yöntemleri ile kapatýldýðý açýk karýn (AK) uygulamasýdýr. Bu amaçla kullanýlan baþlýca yöntemler Vacum Asisted Closure Method (VACM) ve non-vacum asisted closure (NVACM) teknikleridir. Bu çalýþmada farklý karýn kapama yöntemlerinin morbidite ve mortalite üzerine olan etkileri incelendi.
GEREÇ VE YÖNTEM: Çalýþmada 2013–2016 yýllarý arasýnda AK uygulanan hastalarýn geçici karýn kapama yöntemleri geriye dönük olarak incelendi.
VACM ile NVACM uygulanan hastalarýn AK etiyopatolojisi, mortalite tahmin skorlarý, nihai karýn kapama süresi ve yöntemleri, hastanede yatýþ süresi, geliþen komplikasyon (enteroatmosferik fistül, mesh enfeksiyonu, insizyonel herni) ve mortalite oranlarý belirlenerek karþýlaþtýrýldý.
BULGULAR: Bu çalýþmaya VACM (n=65) ve NVACM (n=58) uygulanan 123 hasta dahil edildi. Gruplarýn (VACM ve NVACM) yaþ, cinsiyet ve etiyopatogenezleri arasýnda fark yoktu (p>0.05). Tedavi döneminde ortalama APACHE 4 ve MODS skorlarý sýrasýyla 47/63 ve 11/14’tü (p<0.05). Gruplarýn yoðun bakým ünitesi ve hastanede ortalama yatýþ süreleri sýrasýyla 11/16 ve 22/28 gündü (p<0.05). Apse, koleksiyon geliþme oraný sýrasýyla %46.2 ve %77.6 idi (p<0.05). Enteroatmosferik fistül geliþme oraný sýrasýyla %15.4 ve %56.9’du. Ortalama karýn kapama zamaný sýrasýyla 13 ve 17 gündü (p<0.05). VACM grubunda 18 (%28), NVACM grubunda 32 (%55) hasta kaybedildi (p<0.05).
TARTIÞMA: Açýk karýn uygulanan hastalarda geçici karýn kapama yöntemi olan VACM diðer yöntemlere göre daha düþük komplikasyon ve mortalite oranýna sahiptir. Ayrýca hastanede yatýþ süresi daha kýsadýr. Açýk karýn tedavisinde etkili ve güvenli bir uygulama yöntemidir.

Anahtar Kelimeler: Baker yöntemi, Bogota-bag, geçici karýn kapama yöntemleri; non-vacuum assisted closure (NVACM); open abdomen; Vacuum Assisted Closure Method (VACM).

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