Open-abdomen (OA) management is a surgical strategy in which the abdominal fascia is intentionally left unclosed after laparotomy and the viscera are protected using a temporary abdominal closure (TAC) technique. It may be required when immediate fascial closure is unsafe because of severe visceral oedema, persistent intra-abdominal hypertension, abdominal compartment syndrome, unresolved intra-abdominal contamination, or the need for planned reassessment of bowel viability and source control. Its use has expanded beyond trauma and damage-control surgery to include selected patients undergoing emergency surgery for severe intra-abdominal sepsis and other complex abdominal conditions.1,2 The decision to leave the abdomen open should be based on the patient’s physiological condition and operative requirements rather than on the severity of the diagnosis alone. The World Society of Emergency Surgery (WSES) guidelines describe OA management as an option when definitive closure would be unsafe or when further operative assessment is necessary. They also emphasize that the abdomen should be closed as soon as the patient’s physiological condition and intra-abdominal circumstances permit.1,2 The management of intra-abdominal hypertension and abdominal compartment syndrome is closely related to this decision. The World Society of the Abdominal Compartment Syndrome has provided consensus definitions and clinical practice guidance to support recognition and management of these conditions.3 Temporary abdominal closure techniques include negative-pressure wound therapy (NPWT), vacuum-pack systems, plastic-sheet or bag-based methods, mesh-mediated techniques, and other approaches that protect the abdominal contents while permitting re-entry. These techniques differ in their ability to manage fluid, protect the viscera, facilitate repeated exploration, and limit lateral fascial retraction. The choice of technique is influenced by available resources, the patient’s condition, and the treating team’s experience. A systematic review by Boele van Hensbroek et al. (2009) described substantial variation in fascial-closure rates across temporary closure techniques, while also highlighting the limitations of the underlying evidence.4 Later reviews have continued to examine closure outcomes and the role of different methods in non-trauma patients.5 Negative-pressure therapy has become an important component of OA care, particularly when used with strategies intended to preserve or progressively restore fascial approximation. However, the availability of different commercial and improvised systems does not mean that their comparative effectiveness is definitively established. A Cochrane review by Cheng et al. (2022) found that the evidence comparing NPWT with alternative temporary closure approaches in non-trauma patients was limited and of very low certainty.6 This uncertainty reinforces the importance of evaluating outcomes in the context of the clinical population and local practice. OA management also requires repeated assessment of source control, bowel viability, abdominal pressure, fluid balance, and the feasibility of definitive closure. The intended endpoint is fascial-to-fascial closure during the index admission whenever this can be achieved safely. If closure is not possible, patients may require prolonged temporary coverage or alternative wound-management strategies, with potential consequences for subsequent abdominal-wall reconstruction. Demetriades (2012) described the importance of coordinated, ongoing management of the open abdomen, including attention to complications and eventual closure.7 These considerations make fascial closure an important outcome, alongside mortality, infection, re-exploration, and length of hospital stay. Despite the development of consensus guidance and accumulating literature, reported outcomes vary with case mix, indication, physiological severity, closure technique, and institutional practice. Studies combining trauma and non-trauma populations may not fully reflect the clinical circumstances of emergency general surgery. A prospective observational study can therefore provide a structured description of patient characteristics, indications for OA management, definitive fascial closure, complications, and in-hospital outcomes within a defined setting. The present study evaluated these outcomes among adults undergoing OA management following emergency laparotomy at a single centre, with definitive fascial closure during the index hospitalization as the primary outcome.

Study Design and Setting This prospective observational study was conducted in the Department of General Surgery at Santiniketan Medical College & Hospital, West Bengal, India. The study evaluated definitive fascial closure and in-hospital outcomes among patients undergoing open-abdomen management following emergency laparotomy. Institutional ethics committee approval was taken before study commencement. Informed consent was obtained according to the approved protocol and institutional requirements. Patient confidentiality was maintained through coded study identifiers and restricted access to identifiable information. Study Duration The study was conducted over six months, from March 2024 to August 2024. Patients were followed from the index operation until discharge or death during the index hospitalization. Study Population The study included adult patients undergoing emergency laparotomy in whom the abdominal fascia was intentionally left open and temporary abdominal closure was performed. The decision to adopt open-abdomen management was made by the treating surgical team according to the clinical condition and operative findings. Sample Size Calculation As this was a single-centre prospective observational study conducted over six months, the sample size was determined by the number of eligible patients available during the study period. No formal statistical sample-size calculation was performed. All eligible patients meeting the inclusion criteria between March 2024 and August 2024 were considered for inclusion. A total of 45 patients were included in the final analysis. Inclusion Criteria • Age ≥18 years. • Emergency laparotomy during the study period. • Intentional open-abdomen management with temporary abdominal closure. • Availability of sufficient clinical documentation to determine the primary outcome. Exclusion Criteria • Postoperative fascial dehiscence without intentional open-abdomen management. • Transfer after initiation of open-abdomen management elsewhere when essential operative details were unavailable. • Insufficient documentation to establish the primary outcome. Patients who died before definitive fascial closure were retained in the study. Study Outcomes The primary outcome was definitive fascial closure during the index hospitalization, defined as approximation and closure of the abdominal fascia before discharge or death. Skin-only closure or coverage without fascial approximation was not considered definitive closure. Secondary outcomes included time to definitive fascial closure, closure within seven days, number of abdominal re-explorations, postoperative complications, ICU length of stay, hospital length of stay, and in-hospital mortality. Study Variables Demographic variables included age and sex. Clinical variables included major comorbidities and the indication for open-abdomen management. Operative variables included the operative diagnosis, gross intra-abdominal contamination, initial temporary abdominal closure method, and changes in the closure method. Outcome variables included definitive fascial closure, time to closure, re-explorations, complications, length of stay, and mortality. Study Procedures and Techniques Eligible patients were identified from emergency surgical admissions and operative records. Data were collected from clinical notes, operative records, and inpatient documentation using a structured format. The index operation was defined as the emergency laparotomy at which open-abdomen management was initiated. Temporary abdominal closure methods were categorized as negative-pressure wound therapy, plastic-sheet or bag-based closure, or other documented techniques. The choice of method was determined by the treating surgical team according to clinical requirements and available resources. The study did not assign or standardize the operative technique. Coccolini et al. (2018) recommend negative-pressure wound therapy, preferably with continuous fascial traction when feasible, as part of open-abdomen management.1 Subsequent abdominal explorations and definitive closure were performed according to the patient's clinical condition and the treating team's assessment. The number of re-explorations was recorded, and the interval between the index operation and definitive fascial closure was calculated in days. Closure within seven days was recorded separately. Definitive closure was undertaken when clinically appropriate, considering the patient's physiological status, adequacy of source control, bowel viability, and feasibility of fascial approximation, consistent with the principles outlined by Coccolini et al. (2018).1 Postoperative complications were recorded from clinical and operative documentation. These included persistent or recurrent intra-abdominal infection, other wound or abdominal complications, and entero-atmospheric fistula. ICU and hospital lengths of stay were recorded in days. In-hospital mortality included deaths occurring during the index hospitalization. Statistical Analysis Continuous variables were summarized as mean ± standard deviation or median and interquartile range, as appropriate. Categorical variables were expressed as frequencies and percentages. The proportion achieving definitive fascial closure was reported with a 95% confidence interval. Comparisons between patients with and without definitive closure were performed using the Mann–Whitney U test for continuous variables and the chi-square or Fisher's exact test for categorical variables, as appropriate. A two-sided p-value <0.05 was considered statistically significant. No multivariable modelling was performed.

A total of 45 patients were included in the study cohort. The mean age was 51.0 ± 13.9 years, and the median age was 54 years (interquartile range [IQR]: 44–61), with an age range of 18–73 years. Males constituted 62.2% of the cohort (n = 28), while females accounted for 37.8% (n = 17). Regarding comorbidities, 17 patients (37.8%) had no major comorbidity documented, while diabetes mellitus was recorded in 10 (22.2%), chronic kidney disease in six (13.3%), other comorbidities in seven (15.6%), and multiple comorbidities in five (11.1%). The baseline demographic and clinical characteristics are presented in Table 1. Table 1. Baseline demographic and clinical characteristics (N = 45) Characteristic Value Age, mean ± SD (years) 51.0 ± 13.9 Age, median (IQR), years 54 (44–61) Age range (years) 18–73 Male, n (%) 28 (62.2) Female, n (%) 17 (37.8) No major comorbidity documented, n (%) 17 (37.8) Diabetes mellitus, n (%) 10 (22.2) Chronic kidney disease, n (%) 6 (13.3) Other comorbidity, n (%) 7 (15.6) Multiple comorbidities, n (%) 5 (11.1) Values are presented as mean ± standard deviation, median (interquartile range), or number (percentage), as appropriate. Severe intra-abdominal sepsis or peritonitis was the most common indication for open-abdomen management, accounting for 19 patients (42.2%). Abdominal compartment syndrome or intra-abdominal hypertension was recorded in 11 patients (24.4%), while damage-control surgery accounted for six cases (13.3%). Other indications were documented in five patients (11.1%), and planned reassessment of bowel viability or unresolved pathology was the indication in four patients (8.9%). The distribution of indications is shown in Table 2. Table 2. Indications for open-abdomen management (N = 45) Indication n (%) Severe intra-abdominal sepsis or peritonitis 19 (42.2) Abdominal compartment syndrome/intra-abdominal hypertension 11 (24.4) Damage-control surgery 6 (13.3) Other indications 5 (11.1) Planned reassessment of bowel viability or unresolved pathology 4 (8.9) Total 45 (100.0) Bowel ischemia with contamination was the most frequently recorded operative diagnosis, occurring in seven patients (15.6%), followed by anastomotic leak in six (13.3%). Bowel obstruction with marked distension, other emergency abdominal conditions, and severe intra-abdominal sepsis with raised intra-abdominal pressure were each recorded in four patients (8.9%). The remaining diagnoses were distributed across several emergency abdominal conditions requiring staged assessment or management. Negative-pressure wound therapy and plastic-sheet or bag-based closure were each recorded as the initial temporary abdominal closure method in 21 patients (46.7%). Other methods were recorded in three patients (6.7%). A change in the temporary closure method during the treatment course was recorded in nine patients (20.0%). The operative diagnoses and temporary abdominal closure methods are presented in Table 3. Table 3. Operative diagnoses and temporary abdominal closure methods (N = 45) A. Operative diagnosis n (%) Bowel ischemia with contamination 7 (15.6) Anastomotic leak 6 (13.3) Bowel obstruction with marked distension 4 (8.9) Other emergency abdominal condition 4 (8.9) Severe intra-abdominal sepsis with raised intra-abdominal pressure 4 (8.9) Severe pancreatitis with abdominal compartment syndrome 3 (6.7) Intra-abdominal abscess with sepsis 3 (6.7) Staged assessment after source control 3 (6.7) Severe bowel injury requiring staged management 3 (6.7) Perforation peritonitis 3 (6.7) Haemorrhage with physiological instability 2 (4.4) Complex intra-abdominal pathology 1 (2.2) Mesenteric ischemia 1 (2.2) Major abdominal trauma 1 (2.2) B. Temporary abdominal closure Negative-pressure wound therapy as initial method 21 (46.7) Plastic-sheet/bag-based closure as initial method 21 (46.7) Other initial method 3 (6.7) Change in temporary closure method during treatment: yes 9 (20.0) Change in temporary closure method during treatment: no 36 (80.0) Definitive fascial closure during the index hospitalization was recorded in 30 patients (66.7%). Thirteen patients (28.9%) were discharged without definitive fascial closure, while two (4.4%) died before closure. The number of abdominal re-explorations after the index operation ranged from zero to four. Three re-explorations were recorded in 12 patients (26.7%), while nine patients (20.0%) underwent no further abdominal re-exploration. The distribution of re-explorations and definitive fascial closure outcomes is presented in Table 4. Table 4. Abdominal re-explorations and definitive fascial closure (N = 45) A. Abdominal re-explorations after the index operation Number of re-explorations n (%) 0 9 (20.0) 1 11 (24.4) 2 11 (24.4) 3 12 (26.7) 4 2 (4.4) B. Definitive fascial closure outcome Outcome n (%) Definitive fascial closure during index hospitalization 30 (66.7) Discharged without definitive fascial closure 13 (28.9) Died before definitive fascial closure 2 (4.4) Among the 30 patients who achieved definitive fascial closure during the index hospitalization, the median time from the index operation to closure was seven days (IQR: 5–8), with a range of 2–14 days. Closure within seven days was achieved in 21 of these 30 patients (70.0%). When all 45 patients were considered, 21 (46.7%) had definitive fascial closure within seven days. These findings are summarized in Table 5. Table 5. Timing of definitive fascial closure Outcome Value Patients achieving definitive fascial closure, n 30 Time to definitive closure, median (IQR), days 7 (5–8) Time to definitive closure, range, days 2–14 Closure within 7 days among patients achieving closure, n/N (%) 21/30 (70.0) Closure within 7 days among all patients, n/N (%) 21/45 (46.7) Persistent or recurrent intra-abdominal infection was recorded in 16 patients (35.6%). Other wound or abdominal complications were recorded in 13 patients (28.9%), while no entero-atmospheric fistula was recorded. The complication outcomes are summarized in Table 6. Table 6. Postoperative complications (N = 45) Complication n (%) Persistent or recurrent intra-abdominal infection 16 (35.6) Other wound or abdominal complication 13 (28.9) Entero-atmospheric fistula 0 (0.0) The complication categories may overlap; therefore, their counts should not be summed to calculate the total number of patients with complications. Patients who achieved definitive fascial closure were compared with those who did not. The median age was 52 years (IQR: 33.5–59.8) in the closure group and 57 years (IQR: 50.5–61.5) in the group without closure; the difference was not statistically significant (p = 0.181). The proportion of males was 66.7% in the closure group and 53.3% in the group without closure (p = 0.517). Gross intra-abdominal contamination was significantly more frequent among patients who did not achieve definitive fascial closure than among those who did (73.3% versus 36.7%; p = 0.029). The number of re-explorations and the recorded occurrence of persistent or recurrent intra-abdominal infection did not differ significantly between the groups. These comparisons are presented in Table 7. Table 7. Comparison according to definitive fascial closure outcome Variable Closure achieved (n = 30) Closure not achieved (n = 15) p-value Age, median (IQR), years 52.0 (33.5–59.8) 57.0 (50.5–61.5) 0.181 Male sex, n (%) 20 (66.7) 8 (53.3) 0.517 Gross intra-abdominal contamination, n (%) 11 (36.7) 11 (73.3) 0.029 Number of re-explorations, median (IQR) 2 (1–3) 1 (0–2.5) 0.220 Persistent or recurrent intra-abdominal infection, n (%) 8 (26.7) 8 (53.3) 0.105 The group without definitive closure includes patients discharged without closure and those who died before closure. Comparisons are unadjusted and should be interpreted cautiously. The median ICU length of stay was eight days (IQR: 5–11), ranging from 2 to 12 days. The median hospital length of stay was 17 days (IQR: 13–22), with a range of 9–29 days. In-hospital mortality was recorded in two patients (4.4%). These outcomes are presented in Table 8. Table 8. Length of stay and in-hospital mortality (N = 45) Outcome Value ICU length of stay, median (IQR), days 8 (5–11) ICU length of stay, range, days 2–12 Hospital length of stay, median (IQR), days 17 (13–22) Hospital length of stay, range, days 9–29 In-hospital mortality, n (%) 2 (4.4)

In this prospective observational cohort, definitive fascial closure during the index hospitalization was documented in 30 of 45 patients (66.7%). Thirteen patients (28.9%) were discharged without definitive fascial closure, while two (4.4%) died before closure. Among patients who achieved closure, the median time to closure was 7 days (IQR 5–8), and 21 of 30 patients (70.0%) underwent closure within seven days. These findings describe closure outcomes within the study cohort. Their interpretation requires consideration of the indications for open-abdomen management, severity of illness, temporary abdominal closure techniques, and institutional practices, all of which vary across published studies. The observed closure proportion is broadly comparable with findings from previous observational studies, although direct comparisons should be made cautiously. Kritayakirana et al. (2010), in a retrospective case series of 103 patients, reported definitive fascial closure during the initial hospitalization in 60% of the urgent non-trauma group.8 In a larger retrospective cohort, Lambertz et al. (2015) reported fascial closure in 137 of 355 patients (39%).9 Differences between these studies and the present cohort may reflect variations in case mix, indications, clinical severity, and management practices. The findings do not establish superior performance by any institution, particularly because the study populations and designs were not identical. The timing of definitive closure is another important consideration. In the present cohort, 70.0% of patients who ultimately achieved closure underwent closure within seven days. Chen et al. (2014), in a systematic review and meta-analysis involving 3,125 patients, reported lower pooled mortality with early compared with delayed fascial closure (12.3% versus 24.8%; RR 0.53, p < 0.0001) and fewer complications (RR 0.68, p < 0.0001).10 These associations support the clinical importance of achieving closure when feasible, but they do not demonstrate that earlier closure alone causes better outcomes. Patients with adequate source control, improved physiological stability, and less persistent intra-abdominal pathology may be more likely to undergo early closure. The present study was not designed to establish a causal relationship between closure timing and outcomes. The relationship between re-exploration and closure also warrants consideration. Lambertz et al. (2015) found that patients who achieved fascial closure underwent earlier second- and third-look operations than patients who did not achieve closure.9 In the present cohort, the median number of re-explorations was two, but the difference between patients who achieved closure and those who did not was not statistically significant. The number and timing of re-explorations may reflect the underlying pathology, the need for repeated source control, bowel viability, and physiological deterioration. Consequently, the association reported by Lambertz et al. should not be interpreted as proof that earlier re-exploration independently produces successful closure.9 Re-exploration is best interpreted alongside the original indication, evolving clinical condition, and closure outcome. Temporary abdominal closure techniques may also influence the likelihood of definitive fascial approximation. Boele van Hensbroek et al. (2009) reviewed 57 case series and found substantial variation in closure rates across techniques; importantly, they identified no comparative studies in their review.4 Atema et al. (2015), examining non-trauma patients, included 4,358 patients across 78 series, 79% of whom had peritonitis.5 Bruhin et al. (2014), in a systematic review of NPWT for open-abdomen management, similarly highlighted differences in reported outcomes according to the clinical context and the use of adjunctive dynamic closure techniques.11 The highest weighted fascial-closure rates were reported in series using NPWT with continuous mesh- or suture-mediated fascial traction (73.1%; 95% CI 63.3–81.0%). However, the authors emphasized the low overall quality of the evidence and the heterogeneity of indications and treatments. Cheatham et al. (2013) compared a commercial NPWT system with Barker’s vacuum-pack technique in a prospective observational study.12 Among patients receiving at least 48 hours of consistent treatment, the 30-day primary fascial-closure rate was 69% with NPWT and 51% with Barker’s technique (p = 0.03). Median time to closure was 9 versus 12 days, respectively, a difference that was not statistically significant (p = 0.12). Cristaudo et al. (2017), in a systematic review and meta-analysis, also reported better closure outcomes with NPWT combined with continuous fascial traction than with NPWT alone.13 Nevertheless, differences in study populations, techniques, and evidence quality limit direct comparisons. In the present cohort, both NPWT and plastic-sheet or bag-based closure were used; the observational design does not establish the comparative effectiveness of these approaches. The uncertainty surrounding temporary closure methods is reinforced by Cheng et al. (2022).6 Their Cochrane review included only two randomized trials involving 74 adults with non-trauma open abdomens, and the evidence was judged to be of very low certainty. The authors could not establish whether NPWT reduced closure time, fistula formation, mortality, or hospital stay compared with a Bogota bag. Mahoney et al. (2022), in an Eastern Association for the Surgery of Trauma systematic review and practice-management guideline, conditionally recommended fascial traction over routine care following damage-control laparotomy.14 The recommendation was based on improved primary myofascial closure without an identified increase in mortality or enterocutaneous fistula. Its specific trauma and damage-control context should be recognized when interpreting its relevance to non-trauma patients. Together, these reviews support reporting closure methods clearly without assuming that one technique is universally superior. Gross contamination was associated with closure status in the present cohort. Contamination was documented in 11 of 15 patients who did not achieve definitive closure (73.3%), compared with 11 of 30 patients who achieved closure (36.7%; p = 0.029). This association is clinically plausible because contamination may accompany severe peritonitis, unresolved infection, or the need for repeated source-control procedures. However, it remains an unadjusted association. Without multivariable analysis, the contribution of contamination cannot be separated from other characteristics, including underlying pathology and physiological instability. The finding therefore identifies contamination as a relevant feature of the cohort but does not establish it as an independent predictor of closure failure. Complications remain important outcomes of open-abdomen management. The present cohort recorded persistent or recurrent intra-abdominal infection in 16 patients (35.6%) and other wound or abdominal complications in 13 (28.9%); no enteroatmospheric fistula was recorded. Bruns et al. (2016), in a prospective observational study of emergency general-surgery patients, reported wound infection in 9 of 63 patients who achieved fascial closure (14%) and fascial dehiscence in 6 (10%).15 Overall in-hospital mortality was 30%, with additional deaths during follow-up. Kritayakirana et al. (2010) reported intestinal fistula formation in 17% of their urgent non-trauma group.8 These findings demonstrate the importance of monitoring complications, but their rates should not be directly compared without considering differences in case mix, definitions, and follow-up. The absence of a recorded fistula in a cohort of 45 patients does not establish that its underlying risk is negligible. In-hospital mortality in the present cohort was 2 of 45 patients (4.4%), while median ICU and hospital stays were 8 and 17 days, respectively. DuBose et al. (2013), studying trauma patients after damage-control laparotomy, reported primary fascial closure in 66% of the overall cohort and identified several factors associated with failure to achieve delayed primary closure.16 Because that study involved severely injured trauma patients, its outcomes are contextual rather than directly comparable. Likewise, mortality and length of stay across open-abdomen studies are influenced by underlying disease, physiological severity, treatment pathways, and follow-up duration. The present results should therefore be interpreted as a description of the study cohort rather than evidence of better or worse outcomes than those reported elsewhere. Overall, this study organizes the assessment of definitive fascial closure, closure timing, re-exploration, complications, and in-hospital outcomes within a single-centre emergency-surgery setting. Its prospective design and explicit definition of definitive closure support consistent outcome reporting. However, the modest sample size, descriptive analysis, and absence of adjusted estimates limit inference about factors associated with closure. Follow-up ended at discharge or death, preventing assessment of later abdominal-wall reconstruction, incisional hernia, and post-discharge mortality. Larger prospective studies using standardized definitions, adequately characterized temporary closure techniques, and longer follow-up would help clarify the relationships between patient characteristics, contamination, closure strategy, and subsequent outcomes. Strengths and Limitations The prospective design allowed systematic documentation of definitive fascial closure, closure timing, re-explorations, complications, and in-hospital outcomes. The explicit definition of definitive closure and inclusion of patients who died before closure strengthened outcome reporting. However, the single-centre setting and small sample size limit generalizability and statistical precision. The descriptive analysis did not permit adjustment for potential confounding factors or identification of independent predictors of closure. Differences in clinical indications and temporary closure techniques may have influenced outcomes. Follow-up was restricted to the index hospitalization, precluding assessment of post-discharge mortality, incisional hernia, delayed reconstruction, and longer-term abdominal-wall outcomes.

Open-abdomen management following emergency laparotomy was associated with definitive fascial closure during the index hospitalization in 66.7% of the study cohort. Closure timing, repeated abdominal exploration, postoperative complications, and length of stay represent important aspects of the clinical course. Gross intra-abdominal contamination was more frequent among patients who did not achieve definitive closure, although this unadjusted association does not establish an independent predictor of closure failure. The findings provide a descriptive account of short-term outcomes in a single-centre setting. Larger prospective studies incorporating standardized outcome definitions, adjusted analyses, and longer follow-up are needed to clarify factors associated with successful closure.

1. Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7. doi:10.1186/s13017-018-0167-4. 2. Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, et al. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg. 2017;12:39. doi:10.1186/s13017-017-0146-1. 3. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190-206. doi:10.1007/s00134-013-2906-z. 4. Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Goslings JC. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33(2):199-207. doi:10.1007/s00268-008-9867-3. 5. Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39(4):912-25. doi:10.1007/s00268-014-2883-6. 6. Cheng Y, Wang K, Gong J, Liu Z, Gong J, Zeng Z, et al. Negative pressure wound therapy for managing the open abdomen in non-trauma patients. Cochrane Database Syst Rev. 2022;5(5):CD013710. doi:10.1002/14651858.CD013710.pub2. 7. Demetriades D. Total management of the open abdomen. Int Wound J. 2012;9 Suppl 1:17-24. doi:10.1111/j.1742-481X.2012.01018.x. 8. Kritayakirana K, Maggio PM, Brundage S, Purtill MA, Staudenmayer K, Spain DA. Outcomes and complications of open abdomen technique for managing non-trauma patients. J Emerg Trauma Shock. 2010;3(2):118-22. doi:10.4103/0974-2700.62106. 9. Lambertz A, Mihatsch C, Röth A, Kalverkamp S, Eickhoff R, Neumann UP, et al. Fascial closure after open abdomen: initial indication and early revisions are decisive factors—a retrospective cohort study. Int J Surg. 2015;13:12-6. doi:10.1016/j.ijsu.2014.11.025. 10. Chen Y, Ye J, Song W, Chen J, Yuan Y, Ren J. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: a systematic review and meta-analysis. Gastroenterol Res Pract. 2014;2014:784056. doi:10.1155/2014/784056. 11. Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N. Systematic review and evidence-based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014;12(10):1105-14. doi:10.1016/j.ijsu.2014.08.396. 12. Cheatham ML, Demetriades D, Fabian TC, Kaplan MJ, Miles WS, Schreiber MA, et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique. World J Surg. 2013;37(9):2018-30. doi:10.1007/s00268-013-2080-z. 13. Cristaudo A, Jennings S, Gunnarsson R, DeCosta A. Complications and mortality associated with temporary abdominal closure techniques: a systematic review and meta-analysis. Am Surg. 2017;83(2):191-216. 14. Mahoney EJ, Bugaev N, Appelbaum R, Goldenberg-Sandau A, Baltazar GA, Posluszny J, et al. Management of the open abdomen: a systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2022;93(3):e110-8. doi:10.1097/TA.0000000000003683. 15. Bruns BR, Ahmad SA, O'Meara L, Tesoriero R, Lauerman M, Klyushnenkova E, et al. Nontrauma open abdomens: a prospective observational study. J Trauma Acute Care Surg. 2016;80(4):631-6. doi:10.1097/TA.0000000000000958. 16. DuBose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, et al. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2013;74(1):113-20. doi:10.1097/TA.0b013e31827891ce.