Safety and feasibility of open abdomen with negative pressure therapy in major liver trauma: a retrospective bicenter study.

Abstract

Background: Abdominal trauma is the third leading cause of death in the young population, and liver trauma is among the most common. For major liver injury, perihepatic packing (PHP) is a life-saving procedure that allows rapid control of the hemorrhage. The use of the open abdomen (OA) represents a strategy for the management of major abdominal trauma. However, the effects of combined use with Negative Pressure Therapy (NPT) in patients with liver trauma are not yet clear. The aim of our study was to evaluate the safety and feasibility of OA with NPT.

Materials and methods: This retrospective bicenter study enrolled all patients affected by liver trauma who underwent operative management from January 2019 to September 2023 at the Emergency Surgical Units of the "A. Cardarelli" Hospital in Naples and the "San Giovanni di Dio e Ruggi d'Aragona" in Salerno. The two groups were compared in terms of intra- and postoperative outcomes.

Results: Out of a total of 213 patients with liver trauma, 43 patients were divided into two groups: group A (24 patients treated with PHP and OA) and group B (19 patients with PHP, OA and NPT). There were no significant differences in terms of demographic data, preoperative characteristics, length of stay, mortality, or intraoperative or postoperative complications. Hb increase at the time of depacking was higher in group B (p = 0.039).

Conclusions: Open Abdomen with Negative Pressure Therapy appears safe and feasible. Furthermore, it does not affect mortality or hospital stay but it seems to be associated with higher hemoglobin (Hb) levels during the depacking phase.