Abdominal Vacuum Therapy for the Open Abdomen - A Retrospective Analysis of 82 Consecutive Patients

Background: The therapy for open abdomen remains challenging. Abdominal vacuum therapy seems to simplify the treatment and to enable a direct fascial closure in a high percentage of the patients. Patients and Methods: A retrospective analysis of 82 consecutive patients who underwent abdominal vacuum therapy between January 2005 and December 2007 was undertaken. Indications, duration of treatment, complications as well as rate and type of abdominal wall closure were evaluated. Results: The 82 consecutive patients consisted of 46% female and 54% male patients with a median age of 65.5 years. The most frequent diagnoses were colorectal carcinoma (24%, n=28, colon n=18 and rectum n=10), inflammatory bowel disease (13%), perforated peptic ulcer (9%), necrotising pancreatitis (7%), peritoneal carcinosis (5%), ileus (5%) and mesenteric ischaemia (4%). The predominant indication for vacuum therapy was peritonitis (88%). Vacuum therapy treatment was applied for a median of 6days (range: 1-73 days). 18 patients (22%) received intraabdominal foam dressings without the fenestrated polyurethane layer. In 70% of all cases the abdominal vacuum therapy was performed without complications. 16 patients (19.5%) developed intestinal fistulas. However, fistulas were not observed among the patients who were treated with foam dressings without a polyurethane layer. Abdominal bleeding was observed in 8 patients (10%) and a persistent abdominal compartment syndrome was seen in one patient. Nine patients (11%) died during hospitalisation. After completion of the intraabdominal vacuum therapy, direct fascial closure was feasible in 35 patients (43%). In 47 patients (57%) an absorbable synthetic mesh was required for fascial closure. Symptomatic incisional hernias occurred in 22% of the patients. Conclusion: Abdominal vacuum therapy simplifies the treatment of patients with abdominal catastrophes such as peritonitis or necrotising pancreatitis. The cost-effective intraperitoneal use of a foam dressing without a fenestrated polyurethane layer was possible without an increased rate of fistulas. This retrospective analysis demonstrates that abdominal vacuum therapy can be performed without complications in the majority of patients. Furthermore, direct fascial closure is possible in almost half of the patients.