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KMID : 0371420231040040237
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Annals of Surgical Treatment and Research
2023 Volume.104 No. 4 p.237 ~ p.247
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The temporary abdominal closure techniques used for trauma patients: a systematic review and meta-analysis
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Heo Yoon-Jung
Kim Dong-Hun
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Abstract
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Purpose : The choice of temporary abdominal closure (TAC) method affects the prognosis of trauma patients. Previous studies on TAC are challenging to extrapolate due to data heterogeneity. We aimed to conduct a systematic review and comparison of various TAC techniques.
Methods : We accessed web-based databases for studies on the clinical outcomes of TAC techniques. Recognized techniques, including negative-pressure wound therapy with or without continuous fascial traction, skin tension, meshes, Bogota bags, and Wittman patches, were classified via a method of closure such as skin-only closure vs. patch closure vs. vacuum closure; and via dynamics of treatment like static therapy (ST) vs. dynamic therapy (DT). Study endpoints included in-hospital mortality, definitive fascial closure (DFC) rate, and incidence of intraabdominal complications.
Results : Among 1,065 identified studies, 37 papers comprising 2,582 trauma patients met the inclusion criteria. The vacuum closure group showed the lowest mortality (13%; 95% confidence interval [CI], 6%?19%) and a moderate DFC rate (74%; 95% CI, 67%?82%). The skin-only closure group showed the highest mortality (35%; 95% CI, 7%?63%) and the highest DFC rate (96%; 95% CI, 93%?99%). In the second group analysis, DT showed better outcomes than ST for all endpoints.
Conclusion : Vacuum closure was favorable in terms of in-hospital mortality, ventral hernia, and peritoneal abscess. Skin-only closure might be an alternative TAC method in carefully selected groups. DT may provide the best results; however, further studies are needed.
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KEYWORD
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Abdominal injuries, Laparotomy, Negative-pressure wound therapy, Open abdomen techniques, Wound and injuries
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