Open Abdomen Management of Intra-Abdominal Infections: Analysis of a Twenty-Year Experience

Abstract

Patients' pre-operative clinical status influences strongly their response to surgical treatment. The management of OA does not affect adversely the survival of patients with intra-abdominal infections, but factors related to the management of OA (duration of OA) seem to affect the possibility of definitive fascial closure.

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

“…Patients may have an OA for days to weeks in some circumstances. The ideal outcome is timely definitive primary fascial closure 381 , 382 …”

Recent developments in the surgical management of complex intra-abdominal infection

“…Improvements in critical care have resulted in an increasing need for surgeons to consider strategies for early abdominal wall reconstruction in patients who survive. Definitive fascial closure is less likely to occur in those with pre‐existing respiratory morbidity, pulmonary oedema, mesenteric ischaemia, hyperglycaemia and impaired renal function, and is less likely as the duration of management with an open abdomen increases. Lambertz and colleagues also noted that fascial closure is less likely to be achieved in patients with pancreatitis, peritonitis, and those who did not undergo treatment with an open abdomen during the initial phase of treatment.…”

Components separation technique is feasible for assisting delayed primary fascial closure of open abdomen

“…Open abdomen (OA) is increasingly used in critically ill surgical patients (1–3). The initial laparostomy procedure is simple to perform and often results in improved organ functions in patients with abdominal compartment syndrome (ACS) or intra-abdominal hypertension (IAH) (4, 5).…”