Temporary Abdominal Closure After Damage Control Laparotomy for Abdominal Trauma: A Systematic Review of Primary Fascial Closure, Mortality and Enteroatmospheric Fistula

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Damage control laparotomy (DCL) aims at three objectives: haemorrhage control, the control of enteric contamination, and reversal of the lethal triad. The abdomen is left open and the temporary abdominal closure (TAC) used in the first operation largely determines whether those objectives are achieved with an abdomen that is definitively closed. In this review we examined whether negative-pressure TAC, especially when coupled with continuous fascial traction, improves primary fascial closure (PFC), mortality and enteroatmospheric fistula (EAF) after DCL for abdominal trauma compared with non-negative pressure. We searched using PRISMA 2020 and prospective PROSPERO registration CRD420261487225, PubMed/MEDLINE, Embase, Scopus, Cochrane Library and Google Scholar from inception to 30 September 2026 for comparative studies of patients aged ≥16 years on the open abdomen after abdominal trauma. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty with GRADE. There was heterogeneity so no pooling of data and the synthesis was narrative. Of the 842 records used, 41 were sent for full-text review and 5 were included (1,512 patients). There was a randomised study, two prospective multicentre studies and two retrospective studies. Negative-pressure wound therapy (NPWT) achieved a PFC rate of 69% vs 51% in the vacuum-packing technique (p = 0.03), while 30-day survival was 14% versus 30% (p = 0.01) and the adjusted odds ratio was 3.17 (95% CI 1.22-8.26). A significant reduction in 90-day mortality was found in the randomised trial when active negative-pressure peritoneal therapy was involved (hazard ratio 0.32 and 95% CI 0.11-0.93). The persistence of mesh-mediated fascial traction was associated with improved survival (log-rank p = 0.019). Failure to attain PFC was predicted by the number of re-explorations (adjusted OR 1.3; 95% CI 1.2-1.6) and the EAF. No technique increased fistula formation. Certainty was low to moderate. NPWT, ideally with continuous fascial traction, should be the default TAC after DCL for abdominal trauma; non-negative pressure techniques can only be acceptable if resources are limited. Re-exploration and closing the fascia at the earliest safe time are the modifiable factors to achieve success.

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