Immediate Closure of Abdominal Cavity with Biologic Mesh versus Temporary Abdominal Closure of Open Abdomen in Non-Trauma Emergency Patients (CLOSE-UP Study)

摘要

Background: In more than 10% of emergency laparotomies in non-trauma patients, primary fascial closure is not achievable because of excessive visceral edema, which leaves the patient with an open abdomen (OA). An OA harbors an inherent high risk of serious complications, and temporary closure devices are used to achieve delayed fascial closure. A potential new strategy in preventing OA is immediate closure during the emergency procedure with a non-crosslinked biologic mesh.Methods: This is a prospective comparative cohort feasibility study in 13 teaching hospitals in the Netherlands. Non-trauma patients who underwent emergency laparotomy in which regular sutured primary fascial closure was not achievable because of excessive intra-abdominal edema were eligible. In one cohort, Biomesh (n = 20), the abdominal cavity was immediately closed at the emergency laparotomy with a non-crosslinked biologic mesh. In a parallel cohort, Control (n = 20), the resulting OA was managed by temporary abdominal closure (TAC; inlay polyglactin [Vicryl (TM)] mesh [n = 7]) or commercial (ABThera(TM)) abdominal negative pressure therapy device (n = 13)). The primary end point was the proportion of closed abdominal cavities at 90 days.Results: At 90 days, 65% (13/20) of the abdominal cavities were closed in the Biomesh cohort versus 45% (9/20) in Controls (p = 0.204). In the Biomesh cohort, seven of 20 (35%) patients had at least one major complication versus 15 of 20 (75%) patients in the Control cohort (p = 0.011). Both the median number of intensive care unit (ICU) and mechanical ventilation days were significantly lower in the Biomesh cohort; one versus 10 (p = 0.002) and 0 versus four (p = 0.003) days, respectively. The number of abdominal reoperations was significantly lower in the Biomesh cohort (median 0 vs. two, p 0.001; total number five vs. 44).Conclusions: If primary fascial closure cannot be achieved at the emergency laparotomy in non-trauma patients, immediate abdominal closure by use of a non-crosslinked biologic mesh prevents OA management. This results in a non-significant higher proportion of closed abdominal cavities at 90 days compared with OA management with TAC techniques, and in a significant reduction of major complications and reoperations, and a shorter ICU stay.