Contemporary management of the open abdomen: standards, challenges, and future directions.

Systematic reviewLangenbeck's archives of surgery· May 2026

Contemporary management of the open abdomen: standards, challenges, and future directions.

Miloš Kňazovický, Ivan Kováč, Barbora Romžová … Jana Kaťuchová

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Trauma & Acute Care SurgerySystematic reviewQ1IF 2.2

Negative pressure wound therapy with fascial traction achieves high open abdomen closure rates

Contemporary management of the open abdomen: standards, challenges, and future directions.

Miloš Kňazovický … Jana Kaťuchová

Langenbeck's archives of surgery · May 2026 · Q1 in Surgery

Purpose

The open abdomen (open abdomen) is a key strategy in damage control surgery (damage control surgery) for severe intra-abdominal pathology but is associated with considerable morbidity, including enteroatmospheric fistula (enteroatmospheric fistula) and failure of fascial closure.

Methods

Relevant systematic reviews, meta-analyses, clinical guidelines, registry analyses, and prospective studies published in English were included.

Results

most patients achieved full fascial closure with this approach

80%

Primary closure rate (

90%

Primary closure rate (

More results

Early fascial closure (within 5-7 days) is associated with fewer complications, particularly enteroatmospheric fistula.

Early enteral nutrition (24-48 h), when feasible, may support fascial approximation.

More results

However, available evidence is largely observational and heterogeneous, with substantial inter-institutional variability.

“

Conclusion · 1 of 2

Optimal open abdomen management requires appropriate indication, standardized temporary abdominal closure strategies, and a proactive approach to early closure.

Conclusion · 2 of 2

When primary closure is not feasible, a planned ventral hernia remains a safe alternative. High-quality prospective studies are needed to strengthen the evidence base.

Contemporary management of the open abdomen: standards, challenges, and future directions.

Contemporary management of the open abdomen: standards, challenges, and future directions.

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