Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae


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Abstract

AimReports suggested an increase in enterocutaneous fistulae with topical negative pressure (TNP) use in the open abdomen. The purpose of this study was to establish if our experience raises similar concerns.MethodThis is a 5-year prospective analysis, from January 2004 to December 2008, of 42 patients who developed deep wound dehiscence or their abdomen was left open at laparotomy requiring ‘TNP’ to assist in their management. The decision to use TNP was taken if it was felt unwise or not feasible to close the abdomen.ResultsThere were 22 men; the median age was 68 (range 21–88) years. Twenty of 42 patients had peritonitis, 5/42 had oedematous bowel, 5/42 ischaemic gut, one had a large abdominal wall defect following debridement due to methicillin–resistant staphyloccus (MRSA) infection, 11/42 developed deep wound dehiscence. In 30/42, VAC® abdominal dressing system and TNP were applied. In 12/42, VAC® GranuFoam® and TNP were used, of these five patients required a mesh to control the oedematous bowel. Four of 42 patients died. A total of 34 patients had anastomotic lines, 2/42 developed enteric fistulae, and both survived.ConclusionThis study does not support the reports suggesting a higher fistulae rate with TNP. In our opinion, its use in the open abdomen is safe.

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