Background: Definitive abdominal closure in the management of severe intra-abdominal infection remains controversial due to the paucity of data comparing several management strategies. The simplest approach continues to be the use of Bogotá Bag, originally described for the management of catastrophic penetrating abdominal trauma. Nowadays a popular, but expensive alternative is the use of a commercially available negative pressure dressing with reported fascia approximation success up 88% in non-comparative studies. We designed hospital-made innovative, low cost abdominal vacuum system (Bogotá Vacuum) using generic sterile polyurethane foam for open abdomen management.

Objective: The aim of the present analysis is to compare the rates of delayed primary closure, fistula formation, and outcomes between patients who underwent temporary abdominal closure with Bogotá Bag (B. Bag) vs. our innovative Bogotá abdominal vacuum (B. Vacuum) system in patients with severe intra-abdominal infection. The primary end points were the rate of delayed primary fascial closure and enteral fistula rates. Secondary end points were time to delayed primary closure, ICU and hospital length of stay, and mortality.

Methods: We performed a retrospective cohort study of patients who underwent temporary abdominal closure with B. Bag or B. Vacuum pack system at an Acute Care Surgery unit from July 2007 to July 2008.

Results: 664 laparotomies were performed. Ten percent of them (63 consecutive patients) resulted in an open abdomen. B. Bag (26) and B. Vacuum (37) patients were equivalent in age, sex and severity of illness (APACHE II). Delayed primary closure for survivors (25.0% vs. 26.1%, p=0.504), enteral fistula (3.4% vs. 13.5%, 0.387), ICU LOS (7.9±6.8 vs. 10.3±9.5, p=0.426), LOS (23.5±16.9 vs. 28.2±21.5, p=0.493) were not statistical different in the B. Bag or B. Vac system. The time to delayed primary closure (Log-rank test for equality of survivors function) was also not significant (p= 0.67)

Conclusions: Our rates of delayed primary abdominal closure are similar to a recent randomized controlled trial in trauma population (1). We confirmed previous reports where the success for abdominal closure falls in peritonitis-only series. In this cohort, B. Bag and B. Vacuum techniques were not significant different in the rates or the time for delayed primary closure. However, our results indicate a trend toward an increased fistula rate in the B. Vacuum compared with the B. Bag system. This study confirms the need for randomized control trials comparing temporary abdominal closure systems.
(1) Bee TK. Temporary Abdominal Closure Techniques. J Trauma. 2008;65:337