Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen.

PURPOSE: One of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction. METHODS: Twenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT). RESULTS: The mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia. CONCLUSION: Vertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.

The "impossible" rectal anastomosis: a novel use for endoluminal vacuum-assisted therapy.

PURPOSE: Low rectal anastomoses can safely be performed, usually secured by a diverting ostomy. However, in cases of inflammation, extensive scarring, after extensive radiation, or after severe stapler dysfunction the risk for an anastomotic leak may become prohibitively high. We present a novel use for endoluminal vacuum-assisted therapy (EVAT) for otherwise "impossible" low rectal anastomoses. METHODS: Our initial series consisted of 14 consecutive patients who underwent prophylactic EVAT treatment due to unsafe low colorectal anastomosis. The vacuum sponge was placed intraoperatively in cases otherwise calling for a Hartmann's procedure. An open-pored polyurethane sponge was placed prophylactically transanally for a mean duration of 11 days. Patient characteristics, complications, and risk factors were prospectively collected from medical records and analyzed. RESULTS: Between March 2017 and September 2019, we performed this novel technique in 14 patients enabling us to perform an anastomosis. Our collective consisted of 4 female (29%) and 10 male (71%) patients with a medium age of 59 years. Underlying disease was colorectal cancer in 10 patients, ovarian cancer, perforated sigmoid diverticulitis, ischemic colitis and sarcoma in one patient each. Dominant factors putting the anastomosis at extremely high risk were acute inflammation (n = 2), frozen pelvis (n = 2), intraoperative local chemotherapy (n = 2), stapler dysfunction (n = 2), non-closable rectal stump (n = 2), empty pelvis (n = 1) and ultra-low anastomosis (n = 3). Prophylactic EVAT was successful in 92% and gastrointestinal continuity was preserved in all patients. CONCLUSION: This is the first description of prophylactic EVAT treatment. It seems to be a simple and safe method to enforce the high-risk low rectal anastomosis.