| 1. |
- Acosta, Stefan, et al.
(författare)
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Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction
- 2011
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 98:5, s. 735-743
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Tidskriftsartikel (refereegranskat)abstract
- Background: Damage control surgery and temporary open abdomen (OA) have been adopted widely, in both trauma and non-trauma situations. Several techniques for temporary abdominal closure have been developed. The main objective of this study was to evaluate the fascial closure rate in patients after vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) for long-term OA treatment, and to describe complications. Methods: This prospective study included all patients who received VAWCM treatment between 2006 and 2009 at four hospitals. Patients with anticipated OA treatment for fewer than 5 days and those with non-midline incisions were excluded. Results: Among 151 patients treated with an OA, 111 received VAWCM treatment. Median age was 68 years. Median OA treatment time was 14 days. Main disease aetiologies were vascular (45 patients), visceral surgical disease (57) and trauma (9). The fascial closure rate was 76.6 per cent in intention-to-treat analysis and 89 per cent in per-protocol analysis. Eight patients developed an intestinal fistula, of whom seven had intestinal ischaemia. Intestinal fistula was an independent factor associated with failure of fascial closure (odds ratio (OR) 8.55, 95 per cent confidence interval 1.47 to 49.72; P = 0.017). The in-hospital mortality rate was 29.7 per cent. Age (OR 1.21, 1.02 to 1.43; P = 0.027) and failure of fascial closure (OR 44.50, 1.13 to 1748.52; P = 0.043) were independently associated with in-hospital mortality. Conclusion: The VAWCM method provided a high fascial closure rate after long-term treatment of OA. Technique-related complications were few. No patient was left with a large planned ventral hernia.
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| 2. |
- Bjarnason, Thordur, et al.
(författare)
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Evaluation of the Open Abdomen Classification System: A Validity and Reliability Analysis.
- 2014
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 38:12, s. 3112-3124
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Tidskriftsartikel (refereegranskat)abstract
- Classification of the open abdomen (OA) status is essential for clinical studies on the subject and may help to improve OA therapy. This is a validity and reliability analysis of the OA classification proposed by the World Society of the Abdominal Compartment Syndrome in 2013.
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| 3. |
- Bjarnason, Thordur, et al.
(författare)
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One-Year Follow-up After Open Abdomen Therapy With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction
- 2013
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 37:9, s. 2031-2038
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Tidskriftsartikel (refereegranskat)abstract
- Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure. A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted. The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia. Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past.
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| 4. |
- Bjarnason, Thordur
(författare)
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Open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Several life-threatening intra-abdominal conditions may be treated with open abdomen (OA) therapy. Potential complications to OA treatment include damage to the exposed bowel resulting in enteric fistulas, and inability to close the abdomen afterwards resulting in large ventral hernias. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a novel technique for temporary closure of an OA, intended to increase the chances of subsequent delayed primary fascial closure without increasing the risk of complications. A classification system for the OA has been proposed by the World Society of the Abdominal Compartment Syndrome (WSACS), aimed at improving OA therapy and facilitating clinical research, but has not previously been evaluated. Aims: The aims were to study: - Short-term clinical outcome of OA therapy with VAWCM with regards to fascial closure and factors associated with failure of fascial closure, mortality, morbidity and possible technique-related complications. - One-year clinical outcome of OA therapy with VAWCM with regards to the incidence of incisional- and parastomal hernias, abdominal wall discomfort and frequency of hernia repair operations after one year. - Validity and reliability of the 2013 OA classification system by WSACS and to propose instructions for use with the classification. - Physiological effects of vacuum therapy (VAWC) in an OA with regards to the extent of negative pressure reaching the bowel, the efficacy of the VAWC system in draining fluid from the abdominal cavity and whether paraffin gauzes can be effectively used as pressure isolation when placed between the vacuum source and the bowel. Results/conclusions : - VAWCM provided a high fascial closure rate after long-term OA treatment in mostly elderly, non-trauma patients. Technique-related complications were few and fistula incidence and mortality were similar to other studies. - Incisional hernia incidence one year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic and few required surgical repair during the first year. - The validity and reliability analysis of the OA classification system by WSACS showed that each patient’s most complex OA grade, worsening OA grade without later improvement, as well as development of grade C (enteric leak) or grade 4 (entero-atmospheric fistula) were associated with worse outcome (mortality and failure of fascial closure). Every effort should be made to prevent patients from ascending to a more complex OA grade, to try to repair enteric leaks and to avoid enteroatmospheric fistulas. - Negative pressure reaching the bowel during VAWC therapy was limited, regardless of negative pressure setting. Reduced therapy pressure did not lead to reduced pressure at the bowel surface. The system drained the abdominal cavity completely of fluid. Paraffin gauzes were of limited value as a means of isolation against pressure propagation.
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| 5. |
- Bjarnason, Thordur, et al.
(författare)
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Pressure at the Bowel Surface during Topical Negative Pressure Therapy of the Open Abdomen: An Experimental Study in a Porcine Model.
- 2011
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 35, s. 917-923
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Topical negative pressure (TNP) therapy is increasingly used in open abdomen management. It is not known to what extent this pressure propagates through the dressing to the bowel surface, potentially increasing the risk of bowel fistula formation. The present study in a porcine model was designed to evaluate pressure propagation. METHODS: A commercially available TNP therapy system (ABThera/VAC) was applied in six pigs after laparotomy. Pressure sensors were placed in predetermined positions in the dressing and in the abdominal cavity and the pressure was registered at TNP settings of -50, -75, -100, -125, and -150 mmHg. Next, after infusing 200 ml of saline into the abdomen through a catheter, the amount of fluid drained through the system during 10 min of TNP therapy was registered. Finally, pressure was measured above and below eight layers of paraffin gauzes during TNP therapy. RESULTS: Observed pressure within the outer two foams and the foam of the visceral protective layer correlated with preset TNP. The median pressure at the bowel surface was between -2 and -10 mmHg, regardless of preset TNP. Median fluid drainage was 95% of the infused fluid at -75 mmHg and 124% at -150 mmHg. Paraffin gauzes had a limited isolating effect, reducing the pressure by 13% in median. CONCLUSIONS: Negative pressure reaching the bowel surface during TNP therapy with the ABThera system is limited for all TNP levels. Reduced therapy pressure does not lead to reduced pressure at the bowel surface. The system drains the abdominal cavity completely of fluid. Paraffin gauzes are of limited value as a means of pressure isolation.
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| 6. |
- Björck, Martin, et al.
(författare)
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Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Non trauma Surgical Patients
- 2011
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Ingår i: The American surgeon. - 0003-1348 .- 1555-9823. ; 77:7, s. S62-S66
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Tidskriftsartikel (refereegranskat)abstract
- Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are commonly encountered in nontrauma surgical patients. Depending on the etiology of the patient's surgical illness (ruptured abdominal aortic aneurysm, acute pancreatitis, burns, etc.), both the incidence and mortality of IAH/ACS may be quite high. Recent advances in both the diagnosis and resuscitation of these surgical patients have resulted in significantly improved survival over that seen in years past. Intra-abdominal pressure measurements should be performed in any surgical patient who demonstrates risk factors for IAH/ACS.
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