. 2022 Feb;26(1):61-73.

doi: 10.1007/s10029-020-02336-x. Epub 2020 Nov 21.

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters

A G Willms¹, R Schwab¹, M W von Websky², F Berrevoet³, D Tartaglia⁴, K Sörelius^{5

6}, R H Fortelny^{7

8}, M Björck⁹, T Monchal¹⁰, F Brennfleck¹¹, D Bulian¹², C Beltzer¹³, C T Germer¹⁴, J F Lock¹⁵; EURAHS Open Abdomen Group

Collaborators, Affiliations

Collaborators

EURAHS Open Abdomen Group:
C Güsgen, S Schaaf, F Anger, S Fuhr, M Kiesel, R Schmidt, J C Kalff, T O Vilz, C Galatioto, L Cobuccio, A Hoffmann, H J Schlitt, M Heiss, F Muysoms, K Oldhafer, U Dietz, Martin Björck, A Vanlander

Affiliations

¹ Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
² Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
³ Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
⁴ Emergency Surgery Unit, Cisanello University Hospital, Via Paradisa 1, 56124, Pisa, Italy.
⁵ Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
⁶ Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
⁷ Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria.
⁸ Medical Faculty, Sigmund Freud University of Vienna, 1020, Vienna, Austria.
⁹ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE 751 85, Uppsala, Sweden.
¹⁰ Department of General Surgery, Sainte Anne Military Hospital, 2 Boulevard Sainte-Anne, 83000, Toulon, France.
¹¹ Department of Surgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
¹² Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
¹³ Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg, Ulm, Germany.
¹⁴ Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
¹⁵ Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany. Lock_J@ukw.de.

PMID: 33219419
PMCID: PMC8881440
DOI: 10.1007/s10029-020-02336-x

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters

A G Willms et al. Hernia. 2022 Feb.

. 2022 Feb;26(1):61-73.

doi: 10.1007/s10029-020-02336-x. Epub 2020 Nov 21.

Authors

Collaborators

EURAHS Open Abdomen Group:
C Güsgen, S Schaaf, F Anger, S Fuhr, M Kiesel, R Schmidt, J C Kalff, T O Vilz, C Galatioto, L Cobuccio, A Hoffmann, H J Schlitt, M Heiss, F Muysoms, K Oldhafer, U Dietz, Martin Björck, A Vanlander

Affiliations

¹ Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
² Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
³ Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
⁴ Emergency Surgery Unit, Cisanello University Hospital, Via Paradisa 1, 56124, Pisa, Italy.
⁵ Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
⁶ Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
⁷ Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria.
⁸ Medical Faculty, Sigmund Freud University of Vienna, 1020, Vienna, Austria.
⁹ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE 751 85, Uppsala, Sweden.
¹⁰ Department of General Surgery, Sainte Anne Military Hospital, 2 Boulevard Sainte-Anne, 83000, Toulon, France.
¹¹ Department of Surgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
¹² Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
¹³ Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg, Ulm, Germany.
¹⁴ Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
¹⁵ Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany. Lock_J@ukw.de.

PMID: 33219419
PMCID: PMC8881440
DOI: 10.1007/s10029-020-02336-x

Abstract

Purpose: Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure.

Methods: A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719).

Results: Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC.

Conclusion: The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.

Keywords: Abdominal compartment syndrome; Abdominal trauma; Burst abdomen; Fascial closure; Hernia; NPWT; Open abdomen; Peritonitis; VAC.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. No funding was received for this work.

Figures

**Fig. 1**
Prism flow chart of patient inclusion

**Fig. 2**
Indications for the open abdomen (number of patients)

**Fig. 3**
Open abdomen techniques (number of patients). *VAWCM* vacuum-assisted wound closure and mesh-mediated fascial traction, *VAC* vacuum-assisted closure, *NPWT* negative-pressure wound therapy, *VPL* visceral protective layer, *DFS* dynamic fascial sutures

**Fig. 4**
Open abdomen treatment elements (number of patients). *DCT* dynamic closure techniques, *NPWT* negative-pressure wound therapy, *VPL* visceral protective layer

See this image and copyright information in PMC

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Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters

Collaborators

Affiliations

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters

Authors

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Abstract

Conflict of interest statement

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