gms | German Medical Science

Introduction: The application of the abdominal vacuum assisted closure (VAC) system has become a promising treatment strategy in critical ill patients with abdominal sepsis requiring surgical therapy and open abdomen. However, fascial retraction and high rates of incomplete fascial closure up to 70% with subsequent high incidence of incisional hernia have been reported in literature. In this study we analysed the long term outcome of the abdominal vacuum therapy in patients with abdominal sepsis regarding the incidence of incisional hernia after delayed fascial closure.

Materials and methods: The study retrospectively includes all patients with abdominal sepsis requiring emergency laparotomy with application of abdominal VAC therapy between november 2006 and november 2008 at our department (80 patients, 51 male/29 female; median age 65, range 35 to 87). The follow-up included a clinical examination and abdominal sonography or computed tomography.

Results: The length of VAC therapy ranged from 1 to 13 days (median 4 days) with 0 to 5 changes of the vacuum system (median 1). Complete fascial closure of the abdomen was feasible in 60 patients (75%), partial closure with mesh graft implantation (Vicryl, Goretex) was achieved in 7 patients (8,75%), no closure with planned incisional hernia occurred in 3 patients (3,75%), ten patients died with the VAC system in situ (12,5%). 13 incisional site infections were observed postoperatively. The incidence of incisional hernia after complete or partial fascial closure was 11,9% (8/67) within a median follow-up of 25 months (16–44).

Conclusion: The study confirms the practicability of the abdominal VAC therapy in patients with severe abdominal sepsis showing a high rate of fascial closure and a low incidence of incisional hernia.