Negative Pressure Wound Therapy: Significant Improvement in Definitive Fascial Closure With Reduced Theatre Episodes and Complications in Patients With Encapsulating Peritoneal Sclerosis

Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare condition characterised by recurrent episodes of intestinal obstruction and perforation, usually due to prolonged peritoneal dialysis exposure, resulting in abdominal catastrophes often requiring open abdomen management (OAM). Dynamic negative pressure wound therapies (NPWTs) can facilitate definitive closure in the open abdomen, but consensus recommendations lack high-quality, cohort-specific data. We performed a retrospective analysis on the use of NPWTin this patient cohort to assess its effectiveness when compared to management with static management of the open abdomen. Primary endpoints assessed were: (i) definitive closure; (ii) time to definitive closure; and (iii) method of closure. Secondary endpoints included assessment of complications. Multiple linear and logistic regression analysis assessed variables predictive of primary endpoints. 99 patients were included. 43 (43%) patients were managed with NPWT and 56 (57%) patients with static mechanisms (betadine-soaked gauze.) Patients who were managed with NPWTwere more likely to achieve fascial closure (n=27 vs n=7, p<0.0001), required less total theatre episodes (n=2.27 vs 4.78, p<0.0001), and reported less failure to close episodes (p=0.002). The use of NPWTwas associated with fewer returns to theatre following closure within 30 days (n=4 vs n=19, p=0.004). Failure to close was associated with all-cause mortality (p<0.026). This study demonstrates that NPWT is associated with increased likelihood of fascial closure with a reduced complication profile in patients with EPS, representing a chronically malnourished, high-risk surgical cohort. NPWTshould be within the armamentarium of the general surgeon faced with a complex open abdomen and can be safely used in high-risk surgical patients.

Keywords: abdominal wall; abthera; hernia; npwt; open abdomen.

Figure 1. Multiple logistic regression model estimating the effect of predictors on failure to achieve definitive closure

The development of a fistula is the only factor to significantly predict failure to close versus definitive fascial closure. * = Significant predictor OR: Odds ratio; CI: Confidence interval

Figure 2. Multiple logistic regression model estimating the effect of predictors on achieving fascial closure vs bridged closure

The use of ABTHERA™ rather than static packing is the only factor to predict successful primary fascial closure compared to bridged closure. * = Significant predictor OR: Odds ratio; CI: Confidence interval