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EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

López-Cano, M.; García-Alamino, J. M.; Antoniou, S. A.; Bennet, D.; Dietz, U. A.; Ferreira, F.; Fortelny, R. H.; Hernandez-Granados, P.; Miserez, M. and Montgomery, A. LU , et al. (2018) In Hernia 22(6). p.921-939
Abstract

Purpose: To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used. Methods: The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach including publications up to January 2017. When RCTs were available, outcomes of interest were quantitatively synthesized by means of a conventional meta-analysis. When only observational studies were available, a meta-analysis of proportions was done. The guidelines were written using the AGREE II instrument. Results: For many of the Key... (More)

Purpose: To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used. Methods: The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach including publications up to January 2017. When RCTs were available, outcomes of interest were quantitatively synthesized by means of a conventional meta-analysis. When only observational studies were available, a meta-analysis of proportions was done. The guidelines were written using the AGREE II instrument. Results: For many of the Key Questions that were researched, there were no high quality studies available. While some strong recommendations could be made according to GRADE, the guidelines also contain good practice statements and clinical expertise guidance which are distinct from recommendations that have been formally categorized using GRADE. Recommendations: When considering the OA, dynamic closure techniques should be prioritized over the use of static closure techniques (strong recommendation). However, for techniques including suture closure, mesh reinforcement, component separation techniques and skin grafting, only clinical expertise guidance was provided. Considering the BA, a clinical expertise guidance statement was advised for dynamic closure techniques. Additionally, a clinical expertise guidance statement concerning suture closure and a good practice statement concerning mesh reinforcement during fascial closure were proposed. The role of advanced techniques such as component separation or relaxing incisions is questioned. In addition, the role of the abdominal girdle seems limited to very selected patients.

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publication status
published
subject
keywords
Abdominal wall closure, Burst abdomen, Evisceration, Fascial dehiscence, Guidelines, Hernia, Open abdomen
in
Hernia
volume
22
issue
6
pages
921 - 939
publisher
Springer
external identifiers
  • scopus:85053382637
ISSN
1265-4906
DOI
10.1007/s10029-018-1818-9
language
English
LU publication?
yes
id
47f59aa6-0e81-43a6-ba02-f8875570400c
date added to LUP
2018-10-24 16:30:49
date last changed
2019-07-16 03:59:03
@article{47f59aa6-0e81-43a6-ba02-f8875570400c,
  abstract     = {<p>Purpose: To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used. Methods: The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach including publications up to January 2017. When RCTs were available, outcomes of interest were quantitatively synthesized by means of a conventional meta-analysis. When only observational studies were available, a meta-analysis of proportions was done. The guidelines were written using the AGREE II instrument. Results: For many of the Key Questions that were researched, there were no high quality studies available. While some strong recommendations could be made according to GRADE, the guidelines also contain good practice statements and clinical expertise guidance which are distinct from recommendations that have been formally categorized using GRADE. Recommendations: When considering the OA, dynamic closure techniques should be prioritized over the use of static closure techniques (strong recommendation). However, for techniques including suture closure, mesh reinforcement, component separation techniques and skin grafting, only clinical expertise guidance was provided. Considering the BA, a clinical expertise guidance statement was advised for dynamic closure techniques. Additionally, a clinical expertise guidance statement concerning suture closure and a good practice statement concerning mesh reinforcement during fascial closure were proposed. The role of advanced techniques such as component separation or relaxing incisions is questioned. In addition, the role of the abdominal girdle seems limited to very selected patients.</p>},
  author       = {López-Cano, M. and García-Alamino, J. M. and Antoniou, S. A. and Bennet, D. and Dietz, U. A. and Ferreira, F. and Fortelny, R. H. and Hernandez-Granados, P. and Miserez, M. and Montgomery, A. and Morales-Conde, S. and Muysoms, F. and Pereira, J. A. and Schwab, R. and Slater, N. and Vanlander, A. and Van Ramshorst, G. H. and Berrevoet, F.},
  issn         = {1265-4906},
  keyword      = {Abdominal wall closure,Burst abdomen,Evisceration,Fascial dehiscence,Guidelines,Hernia,Open abdomen},
  language     = {eng},
  number       = {6},
  pages        = {921--939},
  publisher    = {Springer},
  series       = {Hernia},
  title        = {EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen},
  url          = {http://dx.doi.org/10.1007/s10029-018-1818-9},
  volume       = {22},
  year         = {2018},
}