PDF(Pubmed)
Abstract：
BACKGROUND: Temporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital.
METHODS: A retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles.
RESULTS: A total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3-3.8, p < 0.05).
CONCLUSIONS: In patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.
METHODS: A retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles.
RESULTS: A total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3-3.8, p < 0.05).
CONCLUSIONS: In patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.
摘要：
背景：临时腹部闭合（TAC）技术在管理腹部开放性病例中至关重要，特别是在损伤控制手术中。仅皮肤闭合（SC）和波哥大袋闭合（BBC）是TAC的常用方法，但它们在实现原发性筋膜闭合(PFC)方面的相对有效性尚不清楚.这项研究的目的是评估在三级护理医院接受SC和BBC技术治疗TAC的患者在腹膜炎或腹部创伤病例中的PFC率。
方法：在HayatabadMedicalComplex的外科A部门进行了一项回顾性横断面研究，白沙瓦,从2022年1月到2023年7月。获得了机构审查委员会的批准，并确保患者同意数据使用.包括使用仅皮肤或波哥大袋技术进行临时腹部闭合的患者。排除包括15岁以下或75岁以上的患者，那些有多个腹壁切口的人，和那些有腹部手术的人。数据分析使用SPSS版本25。该研究旨在评估损伤控制手术后的结果，重点关注原发性筋膜闭合率及相关因素。基于机构方案和临床背景选择闭合技术(仅皮肤和波哥大袋)。损伤控制手术（DCS）的适应症包括创伤性和非创伤性紧急情况。使用标准化方法测量腹内压(IAP)。将患者分为SC组和BBC组进行比较。建立了再次手术和原发性筋膜闭合的标准，根据临床评估和多学科团队合作确定的时机和技术。在索引手术期间让患者开放的决定遵循损伤控制手术原则。
结果：本研究共纳入193例患者，其中59.0％接受仅皮肤闭合（SC），41.0％接受波哥大袋闭合（BBC）。患者在队列中表现出相似的人口统计学特征，大多数是男性（73.1％），并且患有非创伤性急腹症（58.0％）。在打开腹部的原因中，严重腹内脓毒症影响51.3%的患者，而42.0%出现血流动力学不稳定。与BBC相比，接受SC的患者原发性筋膜闭合（PFC）的发生率明显更高（85.1％vs.65.8%,p=0.04),筋膜裂开率较低(1.7%vs.7.6%,p=0.052）和伤口感染（p=0.010）。多因素回归分析显示，与BBC相比，SC实现PFC的可能性更高（校正OR=1.7，95％CI：1.3-3.8，p<0.05）。
结论：腹膜炎或腹部创伤患者，在我们的研究人群中，SC的PFC率高于BBC的TAC。然而,需要进一步的研究来验证这些结果,并探讨与不同TAC技术相关的长期结局.
方法：在HayatabadMedicalComplex的外科A部门进行了一项回顾性横断面研究，白沙瓦,从2022年1月到2023年7月。获得了机构审查委员会的批准，并确保患者同意数据使用.包括使用仅皮肤或波哥大袋技术进行临时腹部闭合的患者。排除包括15岁以下或75岁以上的患者，那些有多个腹壁切口的人，和那些有腹部手术的人。数据分析使用SPSS版本25。该研究旨在评估损伤控制手术后的结果，重点关注原发性筋膜闭合率及相关因素。基于机构方案和临床背景选择闭合技术(仅皮肤和波哥大袋)。损伤控制手术（DCS）的适应症包括创伤性和非创伤性紧急情况。使用标准化方法测量腹内压(IAP)。将患者分为SC组和BBC组进行比较。建立了再次手术和原发性筋膜闭合的标准，根据临床评估和多学科团队合作确定的时机和技术。在索引手术期间让患者开放的决定遵循损伤控制手术原则。
结果：本研究共纳入193例患者，其中59.0％接受仅皮肤闭合（SC），41.0％接受波哥大袋闭合（BBC）。患者在队列中表现出相似的人口统计学特征，大多数是男性（73.1％），并且患有非创伤性急腹症（58.0％）。在打开腹部的原因中，严重腹内脓毒症影响51.3%的患者，而42.0%出现血流动力学不稳定。与BBC相比，接受SC的患者原发性筋膜闭合（PFC）的发生率明显更高（85.1％vs.65.8%,p=0.04),筋膜裂开率较低(1.7%vs.7.6%,p=0.052）和伤口感染（p=0.010）。多因素回归分析显示，与BBC相比，SC实现PFC的可能性更高（校正OR=1.7，95％CI：1.3-3.8，p<0.05）。
结论：腹膜炎或腹部创伤患者，在我们的研究人群中，SC的PFC率高于BBC的TAC。然而,需要进一步的研究来验证这些结果,并探讨与不同TAC技术相关的长期结局.
