Modified Technique of Bogota Bag Application Vs Traditional Technique in Terms of Delayed Primary Fascial Closure

Abstract

Open abdomen management is used when primary fascial closure is unsafe after emergency laparotomy due to bowel edema, intra-abdominal sepsis, abdominal compartment risk, or the need for planned re-exploration. The traditional Bogota bag is a simple and low-cost temporary abdominal closure method, but it mainly provides visceral coverage and may not adequately prevent lateral fascial retraction. A modified Bogota bag technique may help preserve fascial approximation and improve delayed primary fascial closure, particularly in resource-limited surgical settings.  Objective: To compare the modified Bogota bag technique with the traditional Bogota bag technique in terms of successful delayed primary fascial closure among patients requiring temporary abdominal closure after emergency midline laparotomy. Methods: This randomized controlled trial was conducted in the Department of Surgery, Mayo Hospital, Lahore, from 2 December 2022 to 2 December 2023. A total of 60 patients aged 12–70 years who underwent emergency midline exploratory laparotomy and required temporary abdominal closure were enrolled and randomized into two equal groups. Group A was managed with the traditional Bogota bag technique, while Group B was managed with the modified Bogota bag technique. The primary outcome was successful delayed primary fascial closure. Secondary outcomes included mortality, re-application of the Bogota bag, fistula formation, and evisceration. Data were analyzed using SPSS version 25.0, and a p-value of ≤0.05 was considered statistically significant.  Results: The mean age of the study population was 48.35 ± 11.82 years, and 43 patients (71.7%) were male. Secondary peritonitis was the most common indication for open abdomen management, observed in 47 patients (78.3%). Successful delayed primary fascial closure was achieved in 7 patients (11.7%) overall. Closure was achieved in 1 patient (3.3%) in the traditional group and 6 patients (20.0%) in the modified group. The modified technique showed a higher probability of delayed primary fascial closure compared with the traditional technique, with a risk ratio of 6.00 (95% CI: 0.77–46.87). Pearson’s chi-square test showed statistical significance (p = 0.044), while Fisher’s exact test was more conservative because of the small number of events (p = 0.103). Mortality was lower in the modified group than in the traditional group, but the difference was not statistically significant. No fistula formation or evisceration was observed in either group. Conclusion: The modified Bogota bag technique was associated with a higher rate of delayed primary fascial closure compared with the traditional technique among patients requiring temporary abdominal closure after emergency midline laparotomy. This simple and low-cost modification may be a useful option in resource-limited settings, although larger multicenter trials are needed to confirm its effectiveness.