Risk factors and algorithm for choosing abdominal closure strategy in staged treatment of penetrating wounds

Objective. To analyze the influence of local and systemic factors on reparative processes of laparotomy wound for optimized choice of abdominal closure strategy. Material and methods. A retrospective analysis enrolled 62 patients with penetrating abdominal wounds. Local (intra-abdominal complications, risk of abdominal compartment syndrome, number of relaparotomies) and systemic (total blood protein and urea) factors were assessed. Results. Statistical analysis revealed predictors of suture failure. Independent risk factors of aponeurotic suture failure were serum urea (odds ratio 0.754; p=0.020) and total protein (odds ratio 1.195; p=0.028) upon abdominal closure. Local factors (surgical site infection, peritonitis, abdominal compartment syndrome) were absolutely associated with failure (p<0.001). Conclusion. A formalized algorithm consistently evaluates local factors and serum protein/urea with high predictive value of positive result (91.11%). Original algorithm objectifies the choice of abdominal closure strategy (primary suturing, controlled negative pressure or programmable hernia) and minimizes the risk of suture failure.