The number of operations negatively influences fascia closure in open abdomen management

Background: Open abdomen management applies to a variety of traumatic and inflammatory abdominal conditions. One complication of this technique is inability to achieve primary closure of the abdominal wall. The aim of this study was to determine if the number of abdominal reexplorations influences the success of abdominal closure. Methods: A review of patients undergoing open abdomen management from January 2007 to 2010 was performed. The indication for surgery, number of operations, and success at primary fascia closure were tabulated. A synthetic or biologic mesh bridge was considered failure to achieve closure. Results: One hundred four patients underwent open abdomen management for trauma, postoperative hemorrhage, infected pancreatic necrosis, and perforated viscus or anastomotic leak. Reoperations ranged from 2 to 25, with a mean of 4.5 reoperations. Primary fascia closure was achieved in 82 patients (79%). Fascia closure was successful in 93% of patients with ≤4 reoperations, whereas closure occurred in 32% of patients having <5 reoperations (P <.05). Conclusions: Greater than 4 reoperations is significantly associated with failure of the primary fascia closure. Efforts to obtain closure should be undertaken within 4 reoperations.