Serial Bogota bag tightening: A pragmatic advance in open abdomen management for resource-limited settings

Table 1 Comparison of temporary abdominal closure techniques

Technique	Cost	Bedside feasible	Time to SSD ≤ 5 cm	Fascial closure rate	Key limitations
Standard Bogota bag[10]	Low (1-2 dollars)	Yes	13 days	35%-45%	No traction; domain loss
Serial bag tightening	Negligible (approximately 0.50 dollar)	Yes	9.94 days	SSD ≤ 5 cm (definitive pending)	Surrogate endpoint
Towel clips[11]	Negligible	Yes	14-21 days	20%-30%	Skin necrosis. Poor traction
Wittmann patch alternatives[12]	Moderate (10-20 dollars)	Partial	10-15 days	50%-60%	Reusability issues, infection
Mosquito net mesh traction	Very low (approximately 1 dollar)	Partial	11-14 days	60%-70%	OR-dependent, availability
ABTheraTM NPWT	High (300+ dollars/dressing)	No	10-14 days	70%-80%	Cost, OR-dependent
Fasciotens®[6,13]	High (approximately three hundred thousand rupees)	Partial	7-9 days	70%-80%	Availability
NPWT + mesh (VAWCM)[9,14-17]	High	No	10-14 days	70%-80%	ECF risk; OR-dependent
Perforated drains[18]	Low	Yes	9.1 days	Not reported	Small series

OR: Operating room; NPWT: Negative pressure wound therapy; VAWCM: Vacuum-assisted wound closure and mesh-mediated fascial traction; ECF: Enterocutaneous fistula; SSD: Skin-to-skin distance.

Table 2 Temporary abdominal closure strategies by resource tier

Setting	TAC strategy	Closure rate	Cost	Availability
High-income	ABTheraTM/VAWCM[9,14-17]	70%-80%	High	High
Middle-income	Fasciotens®/mesh[6,13]	65%-75%	Moderate	Low
Low-income	Serial Bogota[1]	SSD ≤ 5 cm: 100%	Negligible	Universal

TAC: Temporary abdominal closure; SSD: Skin-to-skin distance; VAWCM: Vacuum-assisted wound closure and mesh-mediated fascial traction.

Table 3 Risk profile comparison

Risk	Serial Bogota	Towel clips[11]	NPWT[9]
Skin ischemia	None reported	15%-25%	5%-10%
Suture cut-through	None (polypropylene)	N/A	N/A
Patient discomfort	Minimal (analgesia)	Severe	Moderate
Enterocutaneous fistula	Comparable	Higher	Lower

NPWT: Negative pressure wound therapy; N/A: Not applicable.

Table 4 Study outcomes - serial tightening vs control, mean ± SD

Outcome	Serial tightening (n = 18)	Control (n = 18)	P value
Time to SSD ≤ 5 cm (days)	9.94 ± 1.88	13.0 ± 2.87	0.0003
Hospital stay (days)	17.0 ± 1.85	20.39 ± 3.17	0.0013
Complications	Comparable	Comparable	NS
Mortality	Comparable	Comparable	NS

NS: Not significant; SSD: Skin-to-skin distance.