One-Year Follow-up After Open Abdomen Therapy With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction.
| العنوان: | One-Year Follow-up After Open Abdomen Therapy With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction. |
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| المؤلفون: | Bjarnason, Thordur, Montgomery, Agneta, Ekberg, Olle, Acosta, Stefan, Svensson, Matilda, Wanhainen, A, Björck, Matts, Petersson, Ulf |
| المصدر: | World Journal of Surgery. 37(9):2031-2038 |
| مصطلحات موضوعية: | Medicin och hälsovetenskap, Klinisk medicin, Kirurgi, Medical and Health Sciences, Clinical Medicine, Surgery |
| الوصف: | BACKGROUND: Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure. METHODS: A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted. RESULTS: The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia. CONCLUSIONS: Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past. |
| URL الوصول: | https://lup.lub.lu.se/record/3804190 http://www.ncbi.nlm.nih.gov/pubmed/23703638?dopt=Abstract http://dx.doi.org/10.1007/s00268-013-2082-x |
| قاعدة البيانات: | SwePub |
| تدمد: | 14322323 |
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| DOI: | 10.1007/s00268-013-2082-x |