Negative pressure therapy for open abdominal management in nontraumatic and traumatic emergency surgery: international expert recommendations

Negative pressure therapy (NPT) has emerged as an important adjunct in managing the open abdomen (OA), and as part of a larger planned strategy that includes careful patient selection and anticipated timing and steps for primary fascial closure. There is a need to synthesize the information reported in international society guidelines, meta-analyses, comparative studies and case series into updated recommendations regarding the role of NPT in temporary abdominal closure (TAC). The purpose of this publication is to present recommendations developed by an expert panel, along with supporting evidence, to help guide adjunctive use of NPT in OA. An expert advisory panel of 14 surgeons, specialized in general, emergency, trauma, visceral, and/or hepato-pancreato-biliary surgery, convened in June 2023 to develop evidence-based recommendations for adjunctive use of NPT for TAC in the OA. The panel produced six expert panel recommendation statements. The statements identify NPT as the preferred TAC adjunct for managing the OA and include best practices for complete coverage of the viscera and applying adequate negative pressure. Recommended methodology and content for developing systematic training for all healthcare professionals involved in OA patient care with NPT are outlined. The recommendations emphasize the necessity of timely reexploration within 24–72 hours and the importance of achieving early definitive fascial closure, ideally within 7 days. The statements presented in this document provide an updated evidence-based general framework and a minimal set of guidelines for NPT use in all septic and non-septic OA management.