Low-cost dynamic fascial traction using serial Bogota bag tightening in open abdomen management: A prospective randomized study

BACKGROUND Management of the open abdomen (OA) remains challenging, particularly in low-resource settings. Dynamic fascial traction (DFT) has been shown to improve abdominal wall approximation and reduce morbidity; however, most available techniques are expensive, resource intensive, and supported largely by retrospective data, predominantly in trauma populations. AIM To evaluate the feasibility, safety, and effectiveness of a low-cost DFT technique using serial Bogota bag tightening in patients with an OA, and to compare its impact on time to abdominal wall approximation and hospital stay with conventional non-traction laparostomy management. METHODS This prospective randomized study was conducted at a tertiary-care teaching hospital in North India between April 2023 and June 2024. Adult patients (> 18 years) with complete abdominal dehiscence following emergency laparotomy requiring a laparostomy bag were enrolled. Patients with enterocutaneous or entero-atmospheric fistulae were excluded. Participants were randomized into two groups: A control group managed with a standard laparostomy bag without traction, and a study group in which DFT was achieved by serial tightening of a simple Bogota bag. The primary outcome was the time required to achieve a skin-to-skin distance (SSD) of 5 cm. Secondary outcomes included hospital stay, postoperative nutritional parameters, complications, and mortality. RESULTS A total of 36 patients were randomized equally into the two groups. Baseline demographic, clinical, and laboratory characteristics were comparable. Abdominal tuberculosis and enteric fever were the most common aetiologies. The study group achieved a significantly shorter time to an SSD of 5 cm compared with controls (9.94 ± 1.88 days vs 13.0 ± 2.87 days; P = 0.0003), along with a significantly reduced hospital stay (17.0 ± 1.85 days vs 20.39 ± 3.17 days; P = 0.0013). There were no significant differences between groups in postoperative complications, nutritional outcomes, or mortality. CONCLUSION Serial tightening of a simple Bogota bag is a feasible, safe, and inexpensive method for achieving DFT in patients with an OA. This bedside technique significantly accelerates abdominal wall approximation and shortens hospital stay without increasing morbidity, making it particularly suitable for resource-limited settings. Larger multicentre studies are required to validate long-term outcomes and definitive fascial closure rates.