Open abdomen management: A review of its history and a proposed management algorithm

Abstract

In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic.

Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study

“…The introduction of NPWT in OA after acute surgery could significantly increase the outcome of critically ill patients [11]. Bacterial contamination is reduced, drainage of abdominal fluids is sufficient through permanent negative pressure and abdominal compartment syndrome can be avoided [6][7][8].…”

“…Patients with incisional hernias achieved delayed abdominal closure after 15 (3-62) days and 4 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) reoperations. Patients without incisional hernias had significantly fewer treatment days (6 (3-28)) as well as less reoperations (3 (1-14)) (p \ 0.005).…”

“…Other techniques for fascial approximation during OA therapy are mesh-mediated fascial traction [10] or Wittmann patching [11]. A further crucial issue is the timing of closure: Early closure is often associated with reinfection and reoperation, whereas lateralization of the rectus muscles can complicate abdominal wall reconstruction in case of late fascial closure [11].…”

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

“…Surgeons and team leader decided to insert a deflated REBOA in zone III to eventually manage a pelvic arterial hemorrhage. Surgeons performed a Bogota Bag [20] to manage the patient with open abdomen assessing a secondary survey, while BP increased to 110/70 mmHg and HR was 80/min. Bilateral thoracostomy tubes were positioned for the definitive treatment of the left and suspected right pneumothorax.…”

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

“…The capacity of tissues for healing without tension depends on wound-related factors and the patient's general condition [11] . Independently of the technique used for temporary abdominal wall closure, there is a limited window of 2-3 wk to assess early vs delayed closure [8][9][10][11]13,14] . Early definitive closure (final closure of the abdominal defect within the window of 2-3 wk) is based on the resolution of interstitial edema and the evidence of non-adherence between the bowel loops and the abdominal wall.…”