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

doi:10.4292/wjgpt.v17.i2.118848

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Publication Name

World Journal of Gastrointestinal Pharmacology and Therapeutics

ISSN

2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 118848
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.118848

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

Kamesh Balhara, Ashish Sikaria, Dinesh Saini, Himanshu Agrawal, Nikhil Gupta, Nitin Agarwal, Apoorva Mardi

Kamesh Balhara, Ashish Sikaria, Dinesh Saini, Nikhil Gupta, Nitin Agarwal, Apoorva Mardi, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India

Himanshu Agrawal, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Delhi 110095, India

Co-corresponding authors: Himanshu Agrawal and Nikhil Gupta.

Author contributions: Balhara K and Sikaria A conceptualized and designed the study; Saini D, Agrawal H, and Gupta N were involved in patient recruitment, data acquisition, and clinical management; Agarwal N and Mardi A performed data analysis and interpretation; Agrawal H drafted the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content, approved the final version, and agree to be accountable for all aspects of the work. The designation of two co-corresponding authors for this manuscript is justified by the complementary and substantive roles played by both individuals throughout the lifecycle of the study. Agrawal H was centrally involved in the day-to-day execution of the research, including patient recruitment, clinical management, data acquisition, and primary drafting of the manuscript. He also coordinated internal discussions among co-authors and ensured adherence to ethical and methodological standards. In parallel, Gupta N provided senior academic oversight, contributed significantly to study conception, supervised data interpretation, and guided critical revisions to strengthen the scientific rigor and clinical relevance of the work. Importantly, both authors are affiliated with different institutions, which facilitated multicentric coordination, administrative communication, and responsiveness to editorial and reviewer queries. Designating them as co-corresponding authors ensures continuity, accountability, and timely communication during peer review and post-publication correspondence, while accurately reflecting their shared leadership, intellectual responsibility, and sustained commitment to the study.

Institutional review board statement: This study was reviewed and approved by the Institutional Ethics Committee of Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India, Approval No. F.No. TP (MD/MS) (28/2022)/IEC/ABVIMS/RMLH/1194, dated 13 March 2023. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Clinical trial registration statement: This study was not registered in a clinical trial registry, as trial registration was not mandated at the time of study initiation.

Informed consent statement: Written informed consent was obtained from all participants or their legally authorized representatives prior to enrollment in the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this study.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, BKS Marg, Delhi 110001, India. nikhil_ms26@yahoo.co.in

Received: January 13, 2026
Revised: January 29, 2026
Accepted: February 25, 2026
Published online: June 5, 2026
Processing time: 135 Days and 3.2 Hours

Abstract

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.

Keywords: Open abdomen; Dynamic fascial traction; Bogota bag; Emergency laparotomy; Abdominal wall closure

Core Tip: Dynamic fascial traction (DFT) improves outcomes in open abdomen management but is often limited by cost and resource requirements. This prospective randomized study demonstrates that serial tightening of a simple Bogota bag provides an effective, bedside, and low-cost alternative for achieving DFT, significantly reducing time to abdominal wall approximation and hospital stay without added complications-an approach particularly relevant to low- and middle-income healthcare settings.