A simple, inexpensive, life‐saving way to perform iterative laparotomy in patients with severe intra‐abdominal sepsis

Abstract

Between 1 June 1993 and 31 December 1998, 17 patients underwent temporary abdominal closure with 3L urological irrigation bags, because in most cases, there was massive sepsis leading to the conclusion that primary closure was not advisable. Indicative of the seriousness of these conditions, Apache score averaged 19 (range 10±30). The technique consisted of suturing a double thickness of irrigation bags to each side of the wound, and joining the two bags in the midline with running sutures. Abdominal lavage with large quantities of¯uid was performed every other day. This type of closure was used for a mean duration of 15 days. Mean length of hospitalization was 60 days. There were only three deaths (17.6%). No incisional hernia occurred after the iterative laparotomies. Deleting patients with acute pancreatitis would have reduced the death rate to only 7%. A 3L urological irrigation bag costs £11.60 (24.40$ CAN) while a Marlex mesh costs £81.40 (171.00$ CAN). We conclude that the usage of 3L urological plastic bags is a simple, safe and ef®cient method for temporary closure of the abdomen.

The open abdomen and temporary abdominal closure systems – historical evolution and systematic review

“…Four of those papers could not be translated (two from the Czech Republic, one from Norway and one from Hungary) and five papers could not be obtained. Thus 106 papers were found suitable for inclusion [1,10–113]. There were two randomized trials [1,10], three case–control series [11–13], 14 prospective studies, 77 retrospective studies and 10 were non‐specified.…”

“…A zipper or a zipper mesh was used in 13 reporting the results in 15 series [14,16,20,29,63,96–103]. Eight series described use of a Wittmann patch [31–33,64,104–107], six a Bogotá bag [11,52,108–111], three dynamic retention sutures [112–114] and one skin sutures only [48]. One further report from Russia described the use of a locking device [115].…”

Systematic Review and Meta‐analysis of the Open Abdomen and Temporary Abdominal Closure Techniques in Non‐trauma Patients

“…In eight series (10 %) non-absorbable and/or absorbable meshes were used [14, 21-23, 48, 51, 72, 73]. The Bogota bag was applied in six series (8 %) [13,14,31,46,49,74]. Zippers were applied in five series (6 %) [32,33,44,50,75].…”

The role of open abdomen in non-trauma patient: WSES Consensus Paper

“…NPWT was used alone in 32 studies [ 37 – 68 ], and in 6 studies, NWPT is combined with fascial traction (mesh or sutures) [ 69 – 74 ] and eight series described the use of meshes (non-absorbable and/or absorbable) [ 75 – 81 ]. Six series reported about the Bogota-bag use [ 75 , 82 – 86 ]; five, about Zipper [ 87 – 91 ]; and other five, about dynamic retention sutures [ 92 – 96 ]. Two more series described loose packing [ 97 , 98 ].…”