Staged Primary Closure of the Abdominal Wall in Patients with Abdominal Compartment Syndrome

Dynamic Retention Suture Closure: Modified Bogotá Bag Approach

“…The MBB approach was placed for an average of 7.3 d. The technique permitted abdominal wall approximation as early as 4 d and as late as 12 d. The average number of days with an open abdomen was 10.5 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). This is a higher number because the MBB approach was used after an initial damage control surgery following the use of a standard Bogotá bag.…”

“…Small bilateral incisions were made 3 cm apart and 1 cm away from the surgical incision margins. Intravenous tubes were then inserted through the incisions [10]. Jackson-Pratt drains were inserted bilaterally to collect additional fluid.…”

“…In terms of IAP, ACS can be defined as a pressure above 20 mmHg accompanied by single or multiple organ dysfunction [1,9]. Organ involvement is varied and can include respiratory, cardiovascular, and renal system complications [1][2][3][4][5][6][7][10][11][12], which can be detrimental, often fatal, to the patient [10][11][12]. ACS can be classified as primary or secondary depending on the etiology of the intra-abdominal hypertension.…”

“…The available techniques include the historical towel clamp closure of skin, vacuum-assisted dressings, silicone elastomer sheeting, the Bogotá bag and the Wittmann patch [17][18][19]. The Bogotá Bag closure, which consists of a presterilized intravenous (IV) fluid bag that is sutured to the skin, is a widely used technique [10,20]. The Wittmann patch, which consists of two separate Velcro-like pieces that are sutured to the fascia, is another technique that has been effective in allowing serial abdominal closure.…”

“…The previous technique included IV tubing which, acting as dynamic retention sutures, allowed staged closure of the abdominal wall [10]. The MBB approach was used at the Puerto Rico Trauma Center (PRTC) for 11 trauma injured patients, utilizing dynamic retention suture closure after management of an open abdomen.…”