How to deal with an open abdomen?

Abstract

Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure.

Management of the open abdomen using negative pressure wound therapy with instillation in severe abdominal sepsis

“…NPWT resulted in greater rates of fascia closure [14], [15] obviating the need for subsequent hernia repair in many patients [16]. The utility of this technique is not limited to the early postoperative period, but can be successful in for up to 3–4 weeks after the initial operation [17].…”

Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon

“…Although one study found no significant effect of OA‐NPT on pro‐inflammatory cytokines at 24 or 48 hours post‐TAC application, further studies are necessary to determine whether effects exist at other time points. Furthermore, OA‐NPT plays only one part in OA patient management, which includes application of damage control surgery principles , application of the concept of total management of the OA , evolution of TAC techniques from static to dynamic techniques and the evolving theory of gut origin sepsis/toxic lymph/multiple organ dysfunction syndrome . When used synergistically, these principles, concepts and techniques are the primary drivers of improved outcomes in the OA‐NPT patient population.…”

“…Dynamic NPT TAC techniques, such as OA‐NPT, may also diminish the risk of ACS, deferring definitive intervention and anastomosis until the patient has been physiologically optimised and has achieved haemodynamic stability . This clinical approach potentially provides a better surgical outcome and may improve patient survival.…”

“…Patients can then be transferred once haemodynamic stability has been achieved. If no damage control surgery is required, the surgeon can proceed to closure with primary closure of the abdominal wall and fascial closure or abdominal closure with biological mesh (Table ) and/or component separation and/or combination thereof . The author has had extensive experience with the application of a number of biological mesh alternatives.…”

Abdominelles Kompartmentsyndrom, abdominelle Unterdrucktherapie

“…Aus letzerem Grund darf die Unterdrucktherapie in ihrer gewohnten topischen Anwendungsform nicht im Abdomen verwendet werden, da durch den Unterdruck in Kombination mit den okklusiven Wundschaumstoffverbänden ein hohes Risiko für Hohlorganverletzungen mit Ausbildung chronischer enterischer Fisteln, vor allem Dünndarmfisteln, besteht. Dementsprechend mussten für die Anwendung der Unterdrucktherapie im Abdomen spezielle Okklusivverbände mit geeigneten Folien, Schaumstoffen und Gazen entwickelt werden [2,3,4].…”