Technique of Temporary Abdominal Closure Using Negative-Pressure Wound Therapy

Abdallah Alferdaus; Ye Rim Chang; Suk-Kyung Hong

doi:10.69474/jsie.2025.00010

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How I Do It Technique of Temporary Abdominal Closure Using Negative-Pressure Wound Therapy: Abdallah Alferdaus^1,2, Ye Rim Chang¹, Suk-Kyung Hong¹; Journal of Surgical Innovation and Education 2025;2(1):19-21.
DOI: https://doi.org/10.69474/jsie.2025.00010
Published online: June 19, 2025

¹Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

²Trauma and Acute Care Surgery Division, Department of Surgery, Aseer Central Hospital, Abha, Saudi Arabia

Corresponding author: Ye Rim Chang, MD, PhD Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea Tel: +82-2-3010-3465, Fax: +82-2-3010-6863, E-mail: yrchang@amc.seoul.kr

• Received: April 30, 2025 • Revised: May 28, 2025 • Accepted: June 5, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Introduction
Case Presentation
Discussion
NOTES
REFERENCES

Abstract

Temporary abdominal closure (TAC) is an abridged technique used after damage control surgery when primary closure is unattainable or can place patients at risk of complications such as intra-abdominal hypertension. Several techniques have been described for TAC. The ideal method should prevent bowel evisceration, prevent abdominal wall retraction or loss of domain, allow removal of infected fluids, and facilitate early definitive closure. Herein, we present a case where negative-pressure wound therapy was used for TAC. We describe the technique’s steps, aiming to simplify the procedure for experienced surgeons.
Keywords: Open abdomen techniques, Negative-pressure wound therapy, Intra-abdominal hypertension

Introduction

Temporary abdominal closure (TAC) is the chosen procedure to temporarily cover the exposed area of the open abdomen [1]. Various techniques were employed by surgeons as TAC techniques with different outcomes. Those techniques might include dynamic retention sutures, silo techniques, mesh applications, and negative pressure wound therapy (NPWT) [2].

NPWT is having the advantage of actively removing the infected or the toxin-loaded fluids from the peritoneal cavity while preserving the fascia from major retraction. There are two subtypes of the NPWT: the towel-based NPWT like Barker’s vacuum pack and sponge-based NPWT techniques including Ab-Thera Therapy (3M^TM) and Suprasorb-CNP (Lohmann and Rauscher^®). Sponge-based NPWT refers to a method of wound management that involves placing a sponge-like foam interface directly over the wound bed, which is connected to a negative pressure system. We aim to present one of the cases herein explaining the surgical method using towel-based NPWT which is considered a simple and cost-effective method [3].

Ethical statements

With regard to the case report described, an exemption from review was granted by the Institutional Review Board of Asan Medical Center.

Case Presentation

A 54-year-old female with end-stage renal disease had been undergoing peritoneal dialysis since 2005 but was transitioned to hemodialysis in 2008 following an episode of peritonitis. She subsequently underwent kidney transplantation in 2010. She presented to the emergency department with fever and was admitted for treatment of pneumonia, during which her ileus progressively worsened. Conservative measures failed to relieve the obstruction, necessitating surgical intervention.

Intraoperative findings revealed a frozen abdomen with extensive adhesions throughout the entire abdominal cavity. Two sites of bowel perforation were noticed, accompanied by severe fecal contamination. One of the perforations was managed with primary repair, while the other required segmental resection and anastomosis. The procedure was prolonged, with an estimated blood loss of approximately 3 L and persistent diffuse oozing noted at the conclusion of surgery. Abdominal gauze packing was performed, and the patient was transferred to the surgical intensive care unit (ICU) unit under vasopressor support.

Over the following 16 hours, the patient underwent aggressive resuscitation. However, her condition deteriorated, with escalating vasopressor requirements and rising serum lactate levels. Bedside re-exploration was performed, revealing a leak at one of the previous perforation sites. The defect was re-closed and reinforced, and NPWT was applied.

Two days later, the patient was returned to the operating room for a second look procedure. The previously repaired segment was resected, followed by stapled anastomosis and creation of end ileostomy. She was subsequently transferred back to the surgical ICU for ongoing postoperative management.

Surgical technique

The technique used is one of the various ways of negative pressure closures called Barker’s vacuum pack technique which was first described in 1995 [4]. Our approach is composed of the following steps (video):

1. Bring a sterile, non-adherent, transparent sheet (Vi-Drap Isolation Bag; Cardinal Health^TM).

2. Trim away any unnecessary portions to create a single large sheet sufficient to cover the exposed bowel. With the assistance of the surgeon’s assistant, extend the sheet and create multiple small perforations using a scalpel or scissors to facilitate intra-abdominal fluid drainage.

3. Place the fenestrated sheet over the bowel and under the peritoneum of the anterior abdominal wall.

4. Place a sterile surgical towel to cover the fenestrated sheet encompassing two nasogastric tubes.

5. Apply an outer transparent adhesive layer (Ioban 2 Antimicrobial Incise Drape; 3M^TM) over the skin and the towel to maintain a closed seal.

6. Connect the two nasogastric tubes to a continuous wall suction at 100–150 mmHg to expel the intra-peritoneal fluid.

Discussion

TAC is a procedure indicated following damage control surgeries in patients with severe abdominal sepsis, trauma and bowel ischemia. It is also recommended after surgical decompression of abdominal compartment syndrome [2,4]. TAC is an abridged technique aiming to decrease the intra-abdominal pressure to improve perfusion to vital intra-abdominal organs while preventing bowel evisceration, minimizing the abdominal wall retraction, and allowing the removal of intraabdominal fluids [2,3]. Most authors agree upon main goals in managing the open abdomen: achieving early definite closure with minimized complications such as enterocutaneous fistula or intra-abdominal collections [1]. However, the optimal management strategy remains controversial in the current literature.

NPWT compared to other types of TAC is considered advantageous in outcomes such as mortality, early definitive closure, fistula and peritoneal abscess formation rates. The lowest mortality rate was observed in patients who underwent NPWT along with a dynamic fascial traction (DFT) [5]. The mortality rate in patients with vacuum pack-only technique—without DFT—was around 27% compared to 17% in patients with DFT. Mortality rate was more prevalent in patients with skin-only closure [6]. Success of primary fascial closure was observed more often too in patients who underwent NPWT with dynamic fascial traction [5,6]. Vacuum pack alone has a lower fistula rate compared to NPWT with DFT [1]. Vacuum pack alone was noticed to be less in rate of peritoneal abscess formation compared to skin-only closure, Slio technique—Bogota bag—and DFT [6]. Those collected data might be biased as concluded by their authors, and further evidence is warranted.

Disclosure

No potential conflict of interest relevant to this article was reported.

Author contributions

Conceptualization: YRC, SKH; Data curation: YRC, SKH; Supervision: YRC, SKH; Writing–original draft: AA, YRC; Writing–review & editing: AA, YRC, SKH.

Video.

REFERENCES

1. Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7.Article PubMed PMC
2. Brown LR, Rentea RM. Temporary abdominal closure techniques. In: StatPearls [Internet]. StatPearls Publishing; 2025 [cited 2025 Apr 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564378/
3. Betancourt AS, Milagros GC, Sibaja P, Fernandez L, Norwood S. Cost evaluation of temporary abdominal closure methods in abdominal sepsis patients successfully treated with an open abdomen. Should we take temporary abdominal closure methods at face value? Health economic evaluation. Ann Med Surg (Lond). 2020;56:11-16.Article PubMed PMC
4. Ribeiro MAF Jr, Barros EA, De Carvalho SM, Nascimento VP, Neto JC, Fonseca AZ. Comparative study of abdominal cavity temporary closure techniques for damage control. Rev Col Bras Cir. 2016;43:368-373.Article PubMed
5. Roberts DJ, Leppäniemi A, Tolonen M, Mentula P, Björck M, Kirkpatrick AW, et al. The open abdomen in trauma, acute care, and vascular and endovascular surgery: comprehensive, expert, narrative review. BJS Open. 2023;7:zrad084.Article PubMed PMC PDF
6. Heo Y, Kim DH. The temporary abdominal closure techniques used for trauma patients: a systematic review and meta-analysis. Ann Surg Treat Res. 2023;104:237-247.Article PubMed PMC PDF

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Technique of Temporary Abdominal Closure Using Negative-Pressure Wound Therapy

J Surg Innov Educ. 2025;2(1):19-21. Published online June 19, 2025

DOI: https://doi.org/10.69474/jsie.2025.00010

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Technique of Temporary Abdominal Closure Using Negative-Pressure Wound Therapy