Christian Hobeika1, Marc-Antoine Allard2,3,4, Petru-Octav Bucur1,5,6, Salima Naili1, Antonio Sa Cunha1,5,7, Daniel Cherqui1,5,6, Denis Castaing1,5,6, René Adam1,5,7, Eric Vibert1,5,6. 1. Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France. 2. Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France. marcantoineallard@yahoo.fr. 3. Université Paris-Sud, Villejuif, France. marcantoineallard@yahoo.fr. 4. Institut National de la Santé et de la Recherche (INSERM) Unité 935, Paris, France. marcantoineallard@yahoo.fr. 5. Université Paris-Sud, Villejuif, France. 6. INSERM Unité 785, Paris, France. 7. Institut National de la Santé et de la Recherche (INSERM) Unité 935, Paris, France.
Abstract
INTRODUCTION: The optimal management of the open abdomen (OA) after liver transplantation (LT) is unclear. The negative pressure wound therapy (NPWT) has been shown to be safe and can increase the chance for early fascial closure in trauma or septic patients. However, little data are available on the specific setting of LT. We aimed to report our experience of OA after LT, marked by the recent use of NPWT. METHODS: All patients with postponed wall closure after LT, from 2002 to 2014, in a single institution were included and retrospectively analyzed. Our management of OA after LT has shifted from skin-only closure (SOC) followed by abdominal wall reconstruction at a distance to the use of NPWT with early fascial closure. RESULTS: Of the 1559 LTs performed during the study period, immediate abdominal wall closure at the end of transplantation could not be achieved in 46 (2.9%) patients. Of them, SOC was performed in 22 (47.8%) patients, whereas vacuum-assisted closure (VAC) therapy was used in 24 (52.1%) patients. The comprehensive complication indexes (CCI) were similar [CCI: 66 (0-100) in the SOC group vs. 56 (0-100) in the VAC group; p = 0.55]. No evisceration or fistula occurred in both groups. One (4.2%) postoperative bleeding case was reported in the VAC group. Early fascial closure was achieved within a median of 5.5 days (1-12) for the 24 patients (100%) of the VAC group. In four of them, a biological mesh was necessary. Only nine patients (52.9%) of the survivors in the SOC group underwent abdominal reconstruction. CONCLUSION: The NPWT in patients with OA after LT enables early fascial closure with limited morbidity provided a specific attention is given to the risk of bleeding. These results support the use of NPWT as the first option in OA patients after LT.
INTRODUCTION: The optimal management of the open abdomen (OA) after liver transplantation (LT) is unclear. The negative pressure wound therapy (NPWT) has been shown to be safe and can increase the chance for early fascial closure in trauma or septicpatients. However, little data are available on the specific setting of LT. We aimed to report our experience of OA after LT, marked by the recent use of NPWT. METHODS: All patients with postponed wall closure after LT, from 2002 to 2014, in a single institution were included and retrospectively analyzed. Our management of OA after LT has shifted from skin-only closure (SOC) followed by abdominal wall reconstruction at a distance to the use of NPWT with early fascial closure. RESULTS: Of the 1559 LTs performed during the study period, immediate abdominal wall closure at the end of transplantation could not be achieved in 46 (2.9%) patients. Of them, SOC was performed in 22 (47.8%) patients, whereas vacuum-assisted closure (VAC) therapy was used in 24 (52.1%) patients. The comprehensive complication indexes (CCI) were similar [CCI: 66 (0-100) in the SOC group vs. 56 (0-100) in the VAC group; p = 0.55]. No evisceration or fistula occurred in both groups. One (4.2%) postoperative bleeding case was reported in the VAC group. Early fascial closure was achieved within a median of 5.5 days (1-12) for the 24 patients (100%) of the VAC group. In four of them, a biological mesh was necessary. Only nine patients (52.9%) of the survivors in the SOC group underwent abdominal reconstruction. CONCLUSION: The NPWT in patients with OA after LT enables early fascial closure with limited morbidity provided a specific attention is given to the risk of bleeding. These results support the use of NPWT as the first option in OA patients after LT.
Authors: Quinton M Hatch; Lisa M Osterhout; Asma Ashraf; Jeanette Podbielski; Rosemary A Kozar; Charles E Wade; John B Holcomb; Bryan A Cotton Journal: J Trauma Date: 2011-06
Authors: Michael L Cheatham; Demetrios Demetriades; Timothy C Fabian; Mark J Kaplan; William S Miles; Martin A Schreiber; John B Holcomb; Grant Bochicchio; Babak Sarani; Michael F Rotondo Journal: World J Surg Date: 2013-09 Impact factor: 3.352