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Factors Associated with Inability to Perform Delayed Primary Fascial Closure of Open Abdomen in Trauma Patients: a Retrospective Observational Study

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Abstract

It is advised that we should never hesitate in leaving the abdomen open when required. However, once the patient is stabilised, we should close it as soon as possible. But the factors which would hamper delayed primary fascial closure (DPFC) are not well studied. A retrospective 5-year analysis of patients with open abdomen (OA) after trauma laparotomy who survived was conducted. Patients were divided into 2 groups: those in which DPFC was possible and those in whom it was not. Out of the 58 patients that were recruited, DPFC could not be performed in 48 patients. Quantum of fluid resuscitation at 48 h was not associated with an inability to perform DPFC. Early definitive control of bleeding and damage control resuscitation are associated with the ability to perform DPFC in OA patients. Presence of blood stream infections (BSIs), ventilator-associated pneumonia (VAP), and intra-abdominal sepsis (IAS) precluded DPFC.

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Abbreviations

AAST :

American Association for the Surgery of Trauma

BSI :

Blood stream infection

DCL :

Damage control laparotomy

DPFC :

Delayed primary fascial closure

EAF :

Entero-atmospheric fistula

HVI :

Hollow viscus injury

IAS :

Intra-abdominal sepsis

INR :

Indian national rupee

IQR :

Interquartile range

NPC :

Non-primary closure

NPWT :

Negative pressure wound therapy

OA :

Open abdomen

STSG :

Split thickness skin grafting

USD :

US dollar

VAP :

Ventilator-associated pneumonia

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Authors and Affiliations

  1. Department of Trauma & Emergency, AIIMS, Raebareli, India

    Harshit Agarwal

  2. Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India

    Dinesh Bagaria, Sushma Sagar, Subodh Kumar, Biplab Mishra & Amit Gupta

  3. Department of Trauma Surgery, CMC, Vellore, India

    Vignesh Kumar

  4. Department of General Surgery, AIIMS, Jodhpur, India

    Niladri Banerjee

Authors
  1. Harshit Agarwal
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  2. Dinesh Bagaria
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  3. Sushma Sagar
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  4. Subodh Kumar
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  5. Biplab Mishra
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  6. Vignesh Kumar
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  7. Niladri Banerjee
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  8. Amit Gupta
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Correspondence to Amit Gupta.

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Agarwal, H., Bagaria, D., Sagar, S. et al. Factors Associated with Inability to Perform Delayed Primary Fascial Closure of Open Abdomen in Trauma Patients: a Retrospective Observational Study. Indian J Surg 84, 983–989 (2022). https://doi.org/10.1007/s12262-021-03184-4

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  • DOI: https://doi.org/10.1007/s12262-021-03184-4

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