Prospective Evaluation of Vacuum-Assisted Closure in Abdominal Compartment Syndrome and Severe Abdominal Sepsis Daniel Perez, MD, Stefan Wildi, MD, Nicolas Demartines, MD, Matthias Bramkamp, MD, Christian Koehler, MD, Pierre-Alain Clavien, MD, PhD, FACS, FRCS BACKGROUND: Open abdomen treatment because of severe abdominal sepsis and abdominal compartment syndrome remains a difficult task. Different surgical techniques are available and are often used according to the surgeon’s personal experience. Recently, the abdominal vacuum-assisted clo- sure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. In this study, we evaluate the role of this treatment option. STUDY DESIGN: This prospective observational cohort study includes 37 consecutive patients who were tempo- rarily treated with VAC for severe abdominal sepsis or abdominal compartment syndrome, or both. Patients with abdominal trauma were excluded from the study. Thirty-seven patients undergoing major elective laparotomy and primary abdominal closure served as control group. Primary end points were fascial closure rate, physicoemotional recovery, and appearance out- comes 1 year after closure. Secondary end points included mortality, duration of open abdo- men, length of ICU stay, and hospitalization time. RESULTS: Abdomens were left open for 23 days (range 3 to 122 days) with 3.8 dressing changes (range 1 to 22) per patient. Abdominal closure was achieved in 70% (n = 26), with no marked relation to duration of open abdomen treatment (p  0.05). After 3 months, patients with VAC treatment recovered to a physical and mental health status similar to patients in the control group (p  0.05). This status remained stable until the end of the study. Aesthetic outcomes (according to the Vancouver Scar Scale) were considerably poorer in the VAC group compared with controls (p  0.01). CONCLUSIONS: Treatment of laparostomy with VAC for abdominal sepsis and abdominal compartment syn- drome results in a high rate of successful abdominal closure. In addition, patients recover more rapidly, although hypertrophic scars might interfere with body perception. We recommend abdominal VAC system as first option if open abdomen treatment is indicated. (J Am Coll Surg 2007;205:586–592. © 2007 by the American College of Surgeons) Closing an abdomen in the presence of abdominal com- partment syndrome and severe abdominal sepsis remains the subject of many controversies. Although there are cur- rently no standard approaches, few principles are univer- sally accepted, with the common aims to ease and reduce need for staged relaparotomy and enhance wound healing. The most widely used techniques include implantation of a mesh, a saline-soaked towel packing, the “Bogotá bag,” or a synthetic patch sutured to the fascial edges. 1-4 Each of these techniques is associated with major shortcomings, includ- ing bowel fistula formation, retraction of the abdominal fascia, and intestinal adherence to the prosthesis. 1,5,6 In ad- dition, lack of hermetic closure and effective drainage fre- quently causes profuse seeding of ascites, requiring un- pleasant nursing care and complex fluid management. 7 An emerging alternative, introduced about a decade ago for patients after damage-control operation, is the abdom- inal vacuum-assisted closure system (VAC). 8 This modality was claimed to provide a number of advantages related mostly to availability of hermetic closure and to ease re- peated laparotomy. The system consists of a nonadherent Competing Interests Declared: None. Received February 19, 2007; Accepted May 15, 2007. From the Department of Visceral and Transplantation Surgery (Perez, Wildi, Clavien), Department of Internal Medicine (Bramkamp), and Department of Plastic and Reconstructive Surgery, University Hospital, Zurich, Switzerland (Koehler); and Department of Visceral Surgery, University Hospital, Lau- sanne, Switzerland (Demartines). Correspondence address: Pierre-Alain Clavien, MD, PhD, FACS, FRCS, Department of Visceral andTransplantation Surgery, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. email: clavien@chir. unizh.ch 586 © 2007 by the American College of Surgeons ISSN 1072-7515/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2007.05.015