The Value of Vacuum-Assisted Closure in Septic Patients Treated with Laparostomy IOANNIS PLIAKOS, M.D., THEODOSSIS S. PAPAVRAMIDIS,M.D., PH.D., NICK MICHALOPOULOS, M.D., NICKOLAOS DELIGIANNIDIS, M.D., PH.D., ISAAK KESISOGLOU, M.D., PH.D., KONSTANTINOS SAPALIDIS, M.D., PH.D., SPIROS PAPAVRAMIDIS, M.D., PH.D. From the 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece The ideal method of temporary abdominal closure (TAC) should allow rapid closure, easy main- tenance, and wound repair with minimal tissue damage. The aim of this retrospective study is to compare open abdomen outcomes between patients managed with vacuum-assisted closure (VAC), and patients managed with other methods of TAC, when septic abdomen is present. Two groups of patients with septic open abdomen: 27 treated with VAC versus 31 treated with other techniques of TAC. We studied open abdomen duration, number of dressing changes, re-exploration rate, successful abdominal closure rate, overall mortality, and development of enteroatmospheric fistulas. The VAC device demonstrated its superiority concerning open abdomen duration (P \ 0.001), number of dressing changes (P \ 0.001), re-exploration rate (P \ 0.002), successful abdominal closure rate (P \ 0.0001), and development of enteroatmospheric fistulas (P \ 0.00001). Compared with other methods of TAC, our experience with the VAC device demonstrated its advantages con- cerning clinical feasibility. The high rates of direct fascia closure with an acceptable rate of ventral hernias are further benefits of this technique. L APAROSTOMY CONSTITUTES a well-accepted practice for the treatment of a wide range of conditions. The major differences concerning laparotomies in the Americas and in Europe are the indications leading to them. 1–5 Trauma is the major underlying pathology when laparostomy is used in the Americas, whereas on the contrary, a septic abdomen constitutes the major indication for laparostomy in Europe. 1–4, 6 This major difference induces vast fluctuations in the results, the complications, and the morbidity of the laparotomies performed on the two sides of the Atlantic. However, all these differences are not only the result of the different etiology of the laparostomy itself, but they are also re- lated to the temporary abdominal closure (TAC) tech- niques. We prefer using the term laparostomy instead of open abdomen, which are virtually synonyms, because in reality, the abdomen never remains open. It is actually a wide stoma closed by the various TAC techniques. Several techniques are available for TAC and are used according to the surgeon’s personal experience and the availability of materials. Most surgeons con- fronting a laparostomy usually consider one of the fol- lowing TAC techniques: a vacuum-assisted technique (VAC, AbThera, or vacuum pack), artificial burr, dy- namic retention sutures, plastic silo, mesh, zipper, loose packing, or skin approximation. 4, 7–14 VAC (KCI International, San Antonio, TX) constitutes today the gold standard in the treatment of abdominal condi- tions leading to abdominal compartment syndrome (ACS) with a septic abdomen and trauma constituting the major etiopathogenic factors. Over the past years, our team has successfully used this device for temporary management of various conditions leading to ACS and especially to the septic abdomen. 1 The aim of this retrospective study is to compare the open abdomen outcome between patients managed with a VAC device and patients managed with other methods of TAC when a septic abdomen is present. Additionally, we discuss specific problems encountered by each TAC and the reason why we arrived in exclu- sively adopting VAC as the only TAC technique. Material and Methods The present is a retrospective analysis of a pro- spectively formed database that was approved by the AHEPA University Hospital Research Ethics Board and included 58 patients who underwent laparostomy as a result of a septic intra-abdominal condition. The study included consecutive patients over a 10-year pe- riod, from January 2000 to December 2009, at a single Address correspondence and reprint requests to Theodossis S. Papavramidis, M.D., Ph.D., Aigaiou 6, 54655 Thessaloniki, Greece. E-mail: papavramidis@hotmail.com. 1