Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative…

Cohort studyWorld journal of emergency surgery : WJES· Dec 2025

Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative pressure wound therapy?

Francesco Paolo Prete, Giuseppe Massimiliano De Luca, Lucia Ilaria Sgaramella … Mario Testini

Trauma & Acute Care SurgeryCohort studyQ1IF 7.5

After late abdomen closure, 75% of patients still achieved primary fascial closure

Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative pressure wound therapy?

Francesco Paolo Prete … Mario Testini

World journal of emergency surgery · Dec 2025 · Q1 in Surgery

Background

Damage control surgery(damage control surgery) is a well-established approach in emergency laparotomy when physiologic instability necessitates an abbreviated operation.

Methods

From 108 cases of damage control surgery and open abdomen with Negative Pressure Wound Therapy performed between February 2015 and February 2024, 72 consecutive patients treated for severe intraabdominal infections were retrospectively reviewed.

n = 108 cases

Results

most late-closed patients still achieved fascial closure, not a permanent hernia

OR 1.90 (95% CI 1.25 to 2.92)

null 1

1.25

2.92

CI excludes the null - significant

More results

Fifty-six patients had short open abdomen, 16 long open abdomen.

Overall mortality was 23.6%, with APACHE II score the only independent predictor (OR 1.9, 95% CI 1.25-2.92, p = 0.003).

Fifty-two patients survived to achieve early closure and 12 late closure, respectively.

More results

Compared to short open abdomen, in long open abdomen nine patients (56.3%, p < 0.001) experienced intraabdominal complications including enteroatmospheric fistula (EAF-3, 18.8%) and frozen abdomen (7, 43.8%); in 10 patients (87.5%, p < 0.001) Negative Pressure Wound Therapy regimen was modified to isolate and divert effluent or clean a contaminated field.

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Conclusion · 1 of 2

Late closure of the open abdomen for intraabdominal infections may significantly associate with EAF and frozen abdomen.

Conclusion · 2 of 2

In these challenging scenarios Negative Pressure Wound Therapy specific properties may be leveraged to address complex anatomical situations, extensive contamination, or the need for targeted wound-healing responses.

Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative pressure wound therapy?

Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative pressure wound therapy?

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