Haverkort, J.J.M. (2014) Closure rates after open abdominal treatment with the vacuum pack. thesis, Medicine.
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Abstract
Purpose: Definitive closure of the abdomen after open abdominal treatment takes place through primary fascial closure (PC) or secondary closure. The aim of this retrospective analysis is to evaluate PC rates and ventral abdominal hernia formation in patients with an open abdomen (OA). Methods: Medical records of all patients who underwent laparotomy at the department of surgery at University Medical Centre Utrecht between 2008 and 2012 were reviewed. Patients requiring OA treatment were included and treated using the vacuum pack as temporary abdominal cover (TAC). Demographics and treatment variables were recorded to compare successful and failed primary closure. Results: For various surgical indications 1203 laparotomies where performed, 110 subjects met final eligibility. The majority were male (78%) mean(±SD) age was 55.8(±18) years. Mortality was 25%. Mean base deficit 6.9(±8) mmol/L, pH 7.26(±0) and serum lactate 5.0(±4) mmol/L showed a severely ill study population. PC was successful in 62% of patients. 24% of patients failed to achieve primary closure (FPC), 15% of patients were intentionally closed using a mesh without attempting primary closure (ISC). Ventral abdominal hernia incidence was lowest (p=0.016) in the PC group (6%), followed by the ISC (21%) and highest in the FPC group (30%). Duration (p=<0.001) of OA treatment and number of TAC changes (p=0.033) were lowest in the PC group. Conclusion: Primary closure of the OA was achieved in 62% of our severely ill patients. Failure to achieve PC increased both the duration of open abdomen treatment and the risk of ventral abdominal hernia development. We therefore advise to aim for primary closure in an open abdomen.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Wessem, Dr. K.J.P. van and Simmermacher, Dr. R.K.J. and University Medical Centre Utrecht and Karthaus, Dr. A.J.M. and Deventer Ziekenhuis. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1038 |
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