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ID: 286 (Conflict of Interest: K)

Fasciotens – eine neue Behandlungsmethode zur Verhinderung der Faszienretraktion am offenen Abdomen

C.Krieglstein1, G.Lill1, F.Beyer2
1St. Elisabeth Krankenhaus, Köln
2Marien Krankenhaus, Bergisch Gladbach

Einleitung

Fascial retraction remains an unsolved and major problem treating the open abdomen. All available methods are aiming at a secondary stepwise closure after the intestinal swelling has diminished. Fascial retraction often impedes a direct closure.

We developed a new device that aimes to prevent fascial retraction. This device was now tested for the first time in a porcine animal model of open abdomen. Its effect on preventing fascial retraction was investigated.

Material und Methoden

The prospective trial took place at the Center for Experimental Medicine at the University of Cologne, Germany. The trial was approved by the local governmental authority.

Operative treatment was carried out under standardized conditions. 12 pigs were divided in two groups. Both groups received a median laparotomy of 30 cm centered between symphysis and xiphoid under general anaesthesia. Group one was treated with the aid of the new device. With this device a ventrally directed traction was applied to both sides of the abdominal wall for 48 hours. A constant traction of 40 N was applied with the device bearing on thorax and anterior pelvic ring. Group two received a median laparotomy without further surgical procedures.

Drag forces for closing the abdominal fascia were measured immediately after laparotomy as well as after 24 and 48 hours. Measurements were performed in the laparotomy`s center as well as 7,5 cm cranially and caudally. Besides, distances between both fascial edges were measured at predefined traction forces. Craniocaudal fascial length as well as abdominal circumference were taken. Vital parameters and ventilation pressure were recorded. Post mortem all fascial tissues and weight bearing tissues were histologically examined.

Ergebnisse

Over the entire follow-up all pigs demonstrated an increase in abdominal circumference, which was mainly due to generalized edema. In both groups, drag forces for closing the abdomen increased. Group one demonstrated a significantly lesser increase in drag forces over the entire follow-up. For the primary endpoint in the laparotomy’s center at 24 hours, the p-value was <0.001. Distances between the fascial edges yielded similar results. The placement of the device on chest and pelvis didn’t influence vital parameters and ventilation pressure.

Schlussfolgerung

Characteristics of fascial retraction and tension were observed and the new device improves the treatment of the open abdomen. It offers an innovative treatment option to counteract fascial retraction. The device facilitates closing a laparotomy after a longer period without any alloplastic materials or abdominal wall reconstructions. Hereby it should reduce ICU stays and treatment costs.

This trial shows the feasibility of treating open abdomen using our innovative retractor. A human trial is planned.



Fasciotens device in porcine open abdomen under general anaesthesia