The temporary abdominal closure techniques used for trauma patients: a systematic review and meta-analysis
Yoonjung Heo, Dong Hun Kim
Abstract
Purpose: The choice of temporary abdominal closure (TAC) method affects the prognosis of trauma patients.Previous studies on TAC are challenging to extrapolate due to data heterogeneity.We aimed to conduct a systematic review and comparison of various TAC techniques.Methods: We accessed web-based databases for studies on the clinical outcomes of TAC techniques.Recognized techniques, including negative-pressure wound therapy with or without continuous fascial traction, skin tension, meshes, Bogota bags, and Wittman patches, were classified via a method of closure such as skin-only closure vs. patch closure vs. vacuum closure; and via dynamics of treatment like static therapy (ST) vs. dynamic therapy (DT).Study endpoints included in-hospital mortality, definitive fascial closure (DFC) rate, and incidence of intraabdominal complications.Results: Among 1,065 identified studies, 37 papers comprising 2,582 trauma patients met the inclusion criteria.The vacuum closure group showed the lowest mortality (13%; 95% confidence interval [CI], 6%-19%) and a moderate DFC rate (74%; 95% CI, 67%-82%).The skin-only closure group showed the highest mortality (35%; 95% CI, 7%-63%) and the highest DFC rate (96%; 95% CI, 93%-99%).In the second group analysis, DT showed better outcomes than ST for all endpoints.Conclusion: Vacuum closure was favorable in terms of in-hospital mortality, ventral hernia, and peritoneal abscess.Skinonly closure might be an alternative TAC method in carefully selected groups.DT may provide the best results; however, further studies are needed.