Negative pressure wound therapy (NPWT) is a widely used technique for temporary abdominal closure. However, there is still lack of firm guidelines and evidence-based recommendations in the regard of negative pressure level used in open abdomen management. Moreover, the incidence rate of enteroatmospheric fistula (EAF) formation varies in published studies and depends on level of negative pressure used. The main goal of the study was to assess the influence of negative pressure on incidence rate of EAF as well as to evaluate the negative pressure level used by European leaders in OA using NPWT.
A simple questionnaire was send to authors published in the field of NPWT in OA management, based on PubMed database. The following data was included: number of patients, the mean level and range of negative pressure used in both OA complicated with EAF before NPWT implementation and in OA management without EAF, number of EAF formed de novo during NPWT.
A total of 25 questionnaires from European centers were sent back. Finally, a total of 632 patients were qualified for analysis. A mean negative pressure from – 25 mmHg to – 150 mmHg have been reported. In all studies continuous pressure mode was used. The mean negative pressure was - 106.9±18.2 mmHg in EAF- patients whereas 114.5±17.9 mmHg in non-EAF patients (p>0.05). The incidence rate of EAF formed de novo during NPWT therapy was 4.7% (30/632), whereas in 12.8% of patients (81/632) EAF was present before NPWT was introduced. There was no correlation found between level of negative pressure used and incidence rate of EAF formation (p=0.06).
There is no significant correlation between negative pressure used in range from -25 mmHg to – 150 mmHg and formation of EAF. Randomized control trials are highly needed to establish the optimal and safe level of negative pressure used in OA management in both EAF and non-EAF patients.
A increased number of patients treated with OA has been observed. Thus, it is crucial to optimize the therapy in regard of level of negative pressure used
Conflict of Interest
The authors declare that they have no conflict of interest.