Open abdominal vacuum pack technique for the management of severe abdominal complications after cytoreductive surgery in ovarian cancer

Introduction. The aim of this study was to evaluate the indications and management of grade III-IV postoper-ative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis.Methods. Retrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open ab-domen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmen-tal syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh. The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula).Results. Two percent of patients who underwent CRS required VAWC during the study's patient inclusion pe-riod. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used. Median hospital stay was 65 days (range: 18-153). Four patients died during hospitalization, three of these within 30 days of VAWC completion.Conclusion. VAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications.(c) 2023 Published by Elsevier Inc.

Automated summary

This study aimed to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. The results showed that 2% of patients required further management after laparotomy, and the indications included gastrointestinal perforation, necrotic enterocolitis, intestinal ischemia, anastomotic leakages, and intra-abdominal hemorrhages. The use of vacuum-assisted wound closure proved to be effective in reducing the risk of postoperative mortality.