Fascial Closure Rate of Open Abdomen Therapy with Vertical Mesh Mediated Fascial Traction Device – A Propensity-Score Matched Analysis from the EHS Open Abdomen Registry

Background Open abdomen treatment (OAT) is a critical surgical strategy for managing severe intra-abdominal conditions. Early definitive fascial closure (DFC) reduces complications and mortality. While the vacuum-assisted wound closure with mesh-mediated fascial traction (VAWCM) technique is considered the current standard, novel methods such as vertical mesh-mediated fascial traction (VMMFT) with devices like Fasciotens® Abdomen offer a promising alternative. Methods This registry-based, propensity-score matched case-control study compared fascial closure outcomes between VAWCM and VMMFT in patients undergoing OAT, utilizing data from the European Hernia Society Open Abdomen Registry (2015–2024). Patients were matched based on sepsis at OAT initiation and initial fascial defect width. Statistical analyses included descriptive statistics, Chi-square and Mann-Whitney U tests, and logistic regression. Results Of 1119 OAT cases, 39 (3.5%) received VMMFT and 675 (60.3%) VAWCM. After matching, each cohort included 28 patients. The VMMFT group demonstrated a significantly higher DFC rate (intention-to-treat 89.3% vs. 60.7%/per-protocol; p = .01). Logistic regression confirmed VMMFT as a positive predictor for closure (OR 5.392, 95% CI: 1.307–22.523; p = .02). Although ICU stay and ventilation duration were longer in the VMMFT group, the incidence of enteroatmospheric fistula was lower (0% vs. 10.7%, p = .08). Conclusion VMMFT was associated with significantly improved fascial closure rates compared to VAWCM in OAT patients. Despite the limited sample size, these findings support the potential of vertical fascial traction in enhancing OAT outcomes. Further prospective studies are warranted to validate these results and optimize patient selection and protocols. Trial registration: The study was registered in the International Clinical Trials Registry Platform through the German Registry for Clinical Trials (DRKS00031181).