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Comparative Study
. 2025 Apr 26;410(1):147.
doi: 10.1007/s00423-025-03693-w.

Open abdomen versus primary closure in the management of severe abdominal sepsis: What is the right way? Results of the last 5 years of a reference center

Tommaso Guagni  1 , P Prosperi  2 , M Marzano  2 , A Falcone  2 , Matteo Bussotti  3 , C Bergamini  2 , M Mastronardi  4 , A Giordano  2
Affiliations
Comparative Study

Open abdomen versus primary closure in the management of severe abdominal sepsis: What is the right way? Results of the last 5 years of a reference center

Tommaso Guagni et al. Langenbecks Arch Surg. .

Abstract

Purpose: WSES guidelines allow open abdomen (OA) for critically ill patients due to secondary peritonitis in the case of inadequate source control, but this option results quite vague and with a low grade of evidence (Grade 2 C). Moreover, the emerging increasing in literature of complications, makes the use of OA in secondary peritonitis more debated. The aim of our study is to analyze the postoperative outcomes of patients undergoing OA versus primary closure (PC) in secondary peritonitis.

Methods: We collected data from Tertiary Trauma Center from 2019 to 2024. The study included patients who underwent urgent laparotomy for severe secondary peritonitis, divided into two groups based on the strategy chosen in the index laparotomy: PC or OA. We retrospectively analyzed the data, considering as primary outcome post-operative mortality, while as secondary outcomes short terms complications and LOS.

Results: 283 patients fit the research for the diagnosis of peritonitis but only 176 were included as with a WSES-SSS > = 7. 128 patients (72,7%) were in the PC group, while 48 (27,3%) were managed with an OA strategy. There were no statistical differences in terms of mortality (p = 0.371), between the two groups. Complications were higher in the OA group (p = 0.001). From the logistic regression only MPI resulted an independent factor of mortality (p = 0.016; OR 1.080).

Conclusion: The study shows that OA in severe secondary peritonitis does not improve mortality and is associated with higher short-term complications and incisional hernias. However, RCT are necessary to better investigate the role of OA in the management of abdominal sepsis.

Keywords: Abdominal sepsis; Open abdomen; Peritonitis; Primary closure.

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Conflict of interest statement

Declarations. Informed consent: This study does not need for an informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of OA and peritonitis selected in the study
Fig. 2
Fig. 2
Indications for OA performed in the study period
Fig. 3
Fig. 3
a) Statistically significant results. OA = Open Abdomen; PC = Primary closure. b) Statistically significant results; OA = Open Abdomen; PC = Primary closure
Fig. 4
Fig. 4
Distribution of pre, intra and post-operative variables
See this image and copyright information in PMC

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