Clinical efficacy of negative pressure therapy (VAC) in the treatment of hostile abdomen: A narrative review of the literature (2020-2025)

Jefferson-Delgado A. · Revista Colombiana de Cirugia (2026) · DOI: 10.30944/20117582.3004

Resumen

Introduction. Defined by the inability to achieve primary fascial closure after laparotomy, hostile abdomen is associated with sepsis, multiorgan failure, and high mortality. Vacuum-assisted negative pressure therapy (NPWTVAC) has become the gold standard for temporary closure, but the evidence published between 2020 and 2025 remains fragmented. The objective of this review was to comprehensively synthesize the published information. Methods. A narrative review was conducted of the literature identified through searches in PubMed, Scopus, Web of Science, SciELO, LILACS, and Google Scholar, published between January 2020 and April 2025. Results. Thirty-two articles were included. The International Register of Open Abdomen (IROA) reported a mortality rate of 41.2% (67.1% in octogenarians). With early traction (≤ 72 h), definitive fascial closure was achieved in 80% to 93.9% of patients, with an in-hospital mortality of 7.9% to 29.5% and the development of fistulas in less than 5%. In peritonitis, VAC therapy was superior to primary closure (81% vs 54%). Pressures of-75 to-125 mmHg were safe, but pressures >-100 mmHg increased the incidence of fistulas. At 12 months, the SF-36 physical (+14.2) and mental (+11.4) scores improved. Conclusion. NPWT-VAC with early traction improves definitive fascial closure, reduces mortality, and reduces fistulas. Multicenter trials are needed to standardize traction protocols and demonstrate cost-effectiveness and long-term functional outcomes.

Instituciones: Universidad Privada Antenor Orrego