Complications and mortality associated with temporary abdominal closure techniques: a systematic review and meta-analysis

Cristaudo, Adam, Jennings, Scott, Gunnarsson, Ronny, and De Costa, Alan (2017) Complications and mortality associated with temporary abdominal closure techniques: a systematic review and meta-analysis. The American Surgeon, 83 (2). pp. 191-216.

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Abstract

Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov. All studies describing TAC technique use in the open abdomen were eligible for inclusion. Data were analyzed per TAC technique in the form of a meta-analysis. A total of 225 articles were included in the final analysis. A meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure [mean difference (MD): 35% ± 23%; P = 0.0044]. A subsequent meta-analysis involving all included studies confirmed its superiority across outcomes for definitive fascial closure (MD: 19% ± 3%; P < 0.0001), perioperative (MD: −4.0% ± 2.4%; P = 0.0013) and in-hospital (MD: −5.0% ± 2.9%; P = 0.0013) mortality, entero-atmospheric fistula (MD: −2.0% ± 1.8%; P = 0.0041), ventral hernia (MD: −4.0% ± 2.4%; P = 0.0010), and intra-abdominal abscess (MD: −3.1% ± 2.1%; P = 0.0044). Therefore, it was concluded that NPWT with continuous fascial traction is superior to NPWT alone.

Item ID: 49734
Item Type: Article (Research - C1)
ISSN: 1555-9823
Keywords: laparostomy
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Date Deposited: 01 Feb 2018 23:04
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110323 Surgery @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 100%
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