Hobeika C, et al. - The researchers embraced this study to describe their experience of the open abdomen (OA) after liver transplantation (LT), marked by the recent use of negative pressure wound therapy (NPWT). Among patients with OA after LT, the NPWT enabled early fascial closure with limited morbidity, if a specific attention was given to the risk of bleeding. In OA patients after LT, these outcomes supported the use of NPWT as the first option.

Methods

• From 2002 to 2014, the researchers included and retrospectively examined all patients with postponed wall closure after LT in a single institution.
• Their management of OA after LT has shifted from skin-only closure (SOC) followed by abdominal wall reconstruction at a distance to the use of NPWT with early fascial closure.

Results

• Immediate abdominal wall closure at the end of transplantation could not be achieved in 46 (2.9%) patients among the 1559 LTs performed during the study period.
• Out of them, SOC was performed in 22 (47.8%) patients, while vacuum-assisted closure (VAC) therapy was used in 24 (52.1%) patients.
• The comprehensive complication indexes (CCI) were similar [CCI: 66 (0-100) in the SOC group vs 56 (0-100) in the VAC group; p=0.55].
• In both groups, no evisceration or fistula occurred.
• In the VAC group, 1 (4.2%) postoperative bleeding case was reported.
• For the 24 patients (100%) of the VAC group, early fascial closure was achieved within a median of 5.5 days (1-12).
• A biological mesh was necessary in 4 of them.
• In the SOC group, 0nly 9 patients (52.9%) of the survivors underwent abdominal reconstruction.