Temporary abdominal closure with polytetrafluoroethylene prosthetic mesh in critically ill non-trauma patients

A Robin-Lersundi, V Vega Ruiz, J López-Monclús, A Cruz Cidoncha, A Abella Alvarez, D Melero Montes, L Blazquez Hernando, M A García-Ureña
Hernia: the Journal of Hernias and Abdominal Wall Surgery 2015, 19 (2): 329-37

BACKGROUND: Survival in critically ill non-trauma patients may be improved by performing temporary abdominal closure using different surgical techniques. We describe the use of expanded polytetrafluoroethylene (ePTFE) mesh for temporary abdominal closure in a group of critical patients. We also evaluate definitive abdominal wall closure in these patients once they are in a stable condition.

METHOD: We conducted a study of 29 critically ill non-trauma patients who underwent temporary abdominal closure due to sepsis or abdominal compartment syndrome over 7 years at two university hospitals. We analysed factors related to surgical wound type and definitive abdominal wall closure. We evaluated the SAPS 3 severity score and used it to obtain expected mortality. We used the Clavien-Dindo System for Surgical Complications and the Ventral Hernia Working Group Classification during follow-up.

RESULTS: Performing temporary abdominal closure with expanded polytetrafluoroethylene mesh was associated with a mortality rate of 20.68%, which was lower than the expected mortality calculated from the SAPS 3 severity score (38.87 ± 21.60). There was no fistula formation related with this type of prosthetic material. In our study group, definitive abdominal wall closure was performed in the 16 patients who survived (69.5%), and six of them underwent this procedure during the original hospital stay.

CONCLUSION: Temporary abdominal closure with ePTFE mesh is an effective alternative in some circumstances. We observed a higher survival rate than the predicted figure and there were no cases of enteroatmospheric fistulae using this particular surgical technique. ePTFE facilitates definitive abdominal wall closure, once the patient is in a stable condition.

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