LAUSR

Open abdomen treatment (OAT) can manage severe abdominal conditions but is associated with high morbidity and mortality. Main risks are entero-atmospheric fistula (EAF), failure of primary fascial closure, and incisional hernias. In this study, we assessed long-term functional outcomes after OAT to understand which factors impacted most on quality of life (QoL). After a retrospective analysis of 165 consecutive OAT patients treated in our center over a 10 years period, before the implantation of a structured mesh mediated fascial traction concept, a prospective follow-up was initiated. All survivors were invited for a follow-up. 40 datasets including clinical and social follow-up with SF-36 scores were analysed. Primary closure (PC) was achieved in 23% of patients. 3/4 of the others underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of them developed recurrent hernias. 55% percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring. Scar pain was described by 15% of the patients as “moderate” and by 10% as “severe”. While hernia presence and scarring showed no impact, male sex and EAF formation significantly reduced QoL. Despite advantages, OAT is associated with high mortality and morbidity, especially in early era before the implementation of a structured concept. Follow-up revealed that hernia is high and that 25% of patients qualifying for a secondary reconstruction did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population.