Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Yu Chen, Jinning Ye, Wu Song, Jianhui Chen, Yujie Yuan, Jianan Ren, Yu Chen, Jinning Ye, Wu Song, Jianhui Chen, Yujie Yuan, Jianan Ren

Abstract

Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included "open abdomen," "abdominal compartment syndrome," "laparostomy," "celiotomy," "abdominal closure," "primary," "delayed," "permanent," "fascial closure," and "definitive closure." Open abdomen was defined as "fail to close abdominal fascia after a laparotomy." Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

Figures

Figure 1
Figure 1
Early fascial closure versus delayed abdominal closure for mortality rate.
Figure 2
Figure 2
Comparison of postoperative complications after definitive closure between early fascial closure and delayed abdominal closure.
Figure 3
Figure 3
The mean length of ICU stay in early fascial or delayed closure populations. Estimated SD values in some trials were calculated from five percent of correlated mean values.
Figure 4
Figure 4
The mean length of total hospital stay for patients with early fascial closure or delayed closure. Estimated SD values in some trials were calculated from five percent of correlated mean values.

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