In the quiet ledger of emergency surgery, a small group of patients whose abdominal walls were deliberately left open has become the subject of a careful comparison between two ways of slowly drawing the fascia back together. Across a European registry, a matched set of 28 patients treated with vertical mesh traction appeared more often to reach closure than 28 treated with the standard vacuum-assisted approach, though the sample is modest and the uncertainty wide. The authors offer this as a signal worth pursuing rather than a settled answer, reminding us that a promising method must still ea
Vertical Mesh Traction Linked to Higher Fascial Closure in Open Abdomen Therapy, Though Evidence Remains Exploratory
Mortality in the matched cohorts was 21.4% with vertical traction and 17.9% with vacuum-assisted closure, and the vertical group had ICU stays averaging 41 days versus 20 days.
28 patients against 28, drawn from 1,119 open abdomens
Mark
Start with the headline number. Why does 89 percent against 61 percent matter?
Mimi
Closing the fascia is the point of the whole therapy, and earlier closure is linked to fewer complications. A gap that large in closure rates, in matched patients, is the kind of signal worth chasing.
Luke
But it is 28 patients per arm, drawn from only 39 vertical cases in the whole registry. That's thin.
Mark
The odds ratio was 5.39. Is that solid?
Luke
The interval runs from 1.31 to 22.25. The data are compatible with a modest effect or an enormous one. And before matching, the result was not statistically significant.
Mimi
The authors say so themselves. They call it exploratory and hypothesis-generating.
Mark
What about the longer ICU stays in the vertical group?
Mimi
41 days on average versus about 20, and ventilation of 433 hours versus 164. That is a real burden for patients.
Luke
The source doesn't say why. It could be that the device was used in sicker or more complicated patients, or something else. We don't know, and the matching only covered sepsis and defect width.
Mark
Mortality was 21.4 versus 17.9 percent.
Luke
Not a significant difference, and with groups this small it couldn't tell us much either way. Same for the fistula figures, 0 versus 10.7 percent, with p = 0.08.
Mimi
So what comes next is prospective work with standard protocols.
O Pulso
- A fragile abdomen left open after emergency surgery must be closed before complications and mortality rise, and the clock is always running.
- Among 28 matched pairs, vertical traction closed fascia in 89.3% of cases against 60.7% with the standard vacuum method, a gap that surprises clinicians.
- The vertical group paid a steep toll in intensive care, with ICU stays averaging 41 days against 20 and ventilation running far longer.
- Confidence intervals stretch from 1.31 to 22.25, and the unmatched data did not reach statistical significance, so the result is still fragile.
- The authors call the findings exploratory and hypothesis-generating, and a registered prospective study is now the path to clarity.
In the quiet ledger of emergency surgery, a small group of patients whose abdominal walls were deliberately left open has become the subject of a careful comparison between two ways of slowly drawing the fascia back together. Across a European registry, a matched set of 28 patients treated with vertical mesh traction appeared more often to reach closure than 28 treated with the standard vacuum-assisted approach, though the sample is modest and the uncertainty wide. The authors offer this as a signal worth pursuing rather than a settled answer, reminding us that a promising method must still earn its place through larger, more rigorously designed studies before it changes how surgeons care for the most fragile bodies.
Surgeons sometimes leave a patient's abdomen deliberately open after an emergency, to control infection or pressure that would otherwise be lethal. The real work begins afterward, when the fascia must slowly be drawn back together, because earlier closure tends to mean fewer complications and better survival. This study looks at a registry of 1,119 such patients and asks whether a newer approach, vertical mesh traction, might close the wall more reliably than the vacuum-assisted method now considered standard.
The two groups did not start out alike. The vertical patients were more often septic, more often smokers, and more often on immunosuppressants or blood thinners, so the authors matched 28 patients from each group on sepsis and the width of the fascial gap. In these matched cohorts, closure was achieved in 89.3% of vertical cases against 60.7% of standard ones. The difference was real enough to reach statistical significance, yet the confidence interval is so wide that the true effect could be modest or quite large.
The cost was visible. Patients treated vertically spent about twice as long in intensive care and on ventilators, while mortality did not differ meaningfully between the groups. The authors are careful to say that treating teams chose their methods, nothing was randomly assigned, and the findings are observational. They have framed the work as a reason to look harder, not a reason to switch practice, and larger prospective trials with standardized protocols will be needed to know whether the promise holds.
The comparison at the center of this study comes down to 28 patients against 28 patients, drawn from a registry of 1,119 people whose abdomens were deliberately left open after emergency surgery. In open abdomen therapy, surgeons leave the abdominal wall unsealed to manage conditions such as peritonitis or abdominal compartment syndrome. The goal afterward is to bring the fascia back together, a step called definitive fascial closure. Earlier closure is associated with fewer complications and lower mortality.
The data come from the European Hernia Society Open Abdomen Registry, which began collecting cases on May 1, 2015, and was updated in 2021. This analysis covers entries through December 4, 2024. The registry takes in all indications and surgical techniques, requires that patients survive more than 24 hours after open abdomen therapy begins if it was the first operation, and requires informed consent from the patient or a legal representative. Data are pseudonymized, so only the treating hospital can re-identify a patient.
Two traction approaches were compared. The first, vacuum-assisted wound closure with mesh-mediated fascial traction, is the current standard. A mesh is sutured to the fascial edges and tightened gradually over repeat operations. The second, vertical mesh-mediated fascial traction, uses devices such as Fasciotens Abdomen. Of the 1,119 cases, 39 (3.5%) received the vertical method and 675 (60.3%) the standard one. Across the whole registry, fascial closure was achieved in 67.7% of cases when all patients were counted, and 80.0% when patients who died before closure became feasible were excluded. Traction of any kind was used in 748 cases (67.4%).
The two groups were not alike at the start. Before matching, the vertical group had more smokers (35.9% versus 14.8%), more immunosuppression or anticoagulant use (59.0% versus 36.4%), and more sepsis (76.9% versus 41.3%). To compensate, the authors matched patients on two factors: sepsis at the start of therapy and the initial width of the fascial gap. They chose only two because the small number of vertical cases made a larger model risky. This produced two cohorts of 28, each with 71.4% septic patients and an average gap of 13.5 cm. The matching left some imbalance. Renal disease was less common in the vertical group (3.6% versus 21.4%), as was cardiac disease (14.3% versus 53.6%).
In the matched groups, closure was achieved in 89.3% of vertical patients versus 60.7% of standard patients when all were counted (p = .01). Excluding patients who died before closure was feasible, the figures were 100% versus 69.6% (p = .01). Logistic regression gave an odds ratio of 5.39 for closure with the vertical method, with a 95% confidence interval of 1.31 to 22.25 (p = .02). That interval is very wide. In the unmatched data the association was weaker and did not reach significance: the odds ratio was 3.26 (p = 0.063), and 3.34 (p = 0.071) after adjusting for sepsis, gap width, age and BMI. In that adjusted model, sepsis, older age and higher BMI each independently lowered the odds of closure.
The vertical group paid a visible price in intensive care. Their ICU stay averaged 41.2 days versus 19.5, and mechanical ventilation lasted 433 hours versus 164 (both p < 0.01). Hospital stay overall was similar. Mortality did not differ significantly, at 21.4% versus 17.9% (p = 0.74), and both groups averaged five dressing changes. No enteroatmospheric fistulas occurred with the vertical method, against 10.7% with the standard one, though that gap did not reach significance (p = 0.08). Open abdomen duration trended shorter with the vertical method, at 17.8 versus 22.5 days (p = 0.17).
The authors say plainly that the results are observational, exploratory and hypothesis-generating. Treating teams chose the technique, nothing was assigned by protocol, and outcomes were tracked only through the index hospitalization. Their ITT-like and PP-like labels are descriptive, not trial-style analyses. The study was registered in the German Clinical Trials Register on 2 June 2026. Confirming the signal will require larger prospective studies with standardized treatment protocols.
Citações Notáveis
The findings should be interpreted as observational, exploratory, and hypothesis-generating rather than confirmatory.— Study authors
Quer a matéria completa?
Leia o original em Nature ↗