Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2016; 8(8): 590-597
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.590
Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?
Marcelo A F Ribeiro Junior, Emily Alves Barros, Sabrina Marques de Carvalho, Vinicius Pereira Nascimento, José Cruvinel Neto, Alexandre Zanchenko Fonseca
Marcelo A F Ribeiro Junior, Emily Alves Barros, Sabrina Marques de Carvalho, Vinicius Pereira Nascimento, José Cruvinel Neto, Alexandre Zanchenko Fonseca, Department of Surgery, University of Santo Amaro, São Paulo CEP 04829-300, Brazil
Author contributions: Ribeiro Junior MAF, Barros EA, de Carvalho SM, Nascimento VP performed the research; Ribeiro Junior MAF, Cruvinel Neto J and Fonseca AZ analyzed the data; Ribeiro Junior MAF and Fonseca AZ wrote the paper; Ribeiro Junior MAF supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at mfribeiro@unisa.br.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marcelo A F Ribeiro Junior, MD, PhD, Department of Surgery, University of Santo Amaro, Rua Prof. Enéas de Siqueira Neto, 340, São Paulo CEP 04829-300, Brazil. mfribeiro@unisa.br
Telephone: +55-11-21418565
Received: April 20, 2016
Peer-review started: April 20, 2016
First decision: June 6, 2016
Revised: June 23, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: August 27, 2016
Abstract
AIM

To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery.

METHODS

After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed.

RESULTS

The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis.

CONCLUSION

The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity.

Keywords: Trauma, Damage control, Abdominal compartment syndrome, Temporary abdominal closure

Core tip: The authors reviewed several manuscripts published in the last 20 years evaluating the management of the open abdomen. Several techniques have been described and the most popular ones were analyzed. The vacuum assisted closure (vacuum-assisted closure therapy), Bogota bag and Barker technique are currently the most used. The authors evaluate, for each technique, efficiency, complications, mortality and wound control.