Leitlinien der EHS zum management der abdominalwand während der offenen abdominalbehandlung: Aktuelle versorgungskonzepte

Introduction: The open abdomen is a treatment strategy associated with high morbidity and mortality. In order to optimize the patient´s outcome it is necessary to reach the goal of fascial closure at the end of the open abdominal treatment. Aim of this publication is to provide clinical guidelines concerning the key questions in relation to abdominal wall management during open abdominal treatment. Methods: These guidelines were developed using the methods of the GRADE system (grading of recommendations assessment, development and evaluation). They derive from systematic literature searches including publications until January 2017. The answers to the key questions are based on meta-analyses of RCTs and observational studies. The guidelines were written using the AGREE II instrument. Results: During management of the open abdomen, dynamic closure techniques should be prioritized over static techniques (strong recommendation). Concerning other key questions, these guidelines can only provide clinical expertise guidance. This is caused by a lack of sufficient evidence which is based on the heterogeneity of available studies, the small sample sizes, the low number of RCTs and the high number of mostly retrospective monocentric observational studies. In summary, as a clinical expertise guidance a running suture and the use of a prophylactic mesh are recommended during fascial closure. Techniques of component separation need a thorough case by case decision with a risk-benefit analysis. Mesh graft transplantation can be a helpful option in grade IV open abdomen (frozen abdomen) in order to prevent fistula development. Discussion: Analyzing the results of these guidelines it becomes clear that there is a lack of sufficient evidence concerning open abdominal treatment. Despite sound methods, uniform recommendations can hardly be given. Only a few key questions can be answered on a low level of evidence. Therefore, a multicentric, prospective registry-based data collection is mandatory in order to recommend guidelines on a higher level of evidence in the future.