Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome

Abstract

BackgroundManagement of the open abdomen is an increasingly common part of surgical practice. The purpose of this review is to examine the scientific background for the use of temporary abdominal closure (TAC) in the open abdomen as a way to modulate the local and systemic inflammatory response, with an emphasis on decompression after abdominal compartment syndrome (ACS).MethodsA review of the relevant English language literature was conducted. Priority was placed on articles published within the last 5 years.Results/ConclusionRecent data from our group and others have begun to lay the foundation for the concept of TAC as a method to modulate the local and/or systemic inflammatory response in patients with an open abdomen resulting from ACS.

The Use of Laparostomy in Patients With Gynecologic Cancer: First Report From a UK Cancer Center

“…Vasoactive substances are released leading to a systemic inflammatory response characterized by increased endothelial permeability that increases the pressure within the compartment and the cycle continues with gangrene, multiorgan failure, and potentially fatal consequences. 3,5 In ACS, in addition to damage to abdominal viscera, sustained intra-abdominal pressure leads to increased pulmonary peak pressures, respiratory and circulatory failure, and oliguria. 3,6 Subclassification of ACS into primary, secondary, and recurrent has been defined, with primary ACS including those cases associated with surgery.…”

Abdominal negative-pressure therapy: a new method in countering abdominal compartment and peritonitis - prospective study and critical review of literature

“…Patients in whom damage control laparotomy is indicated should be considered for the application of NPT to avoid the development of ACS, visceral hypoperfusion and multiple organ failure [9,10,24,26-29]. Unfortunately, until now, randomised trials demonstrating the superiority of any particular TAC technique are lacking [5,30]. …”

Kidney Injury in Abdominal Compartment Syndrome

“…Shah et al reviewed substantial evidence suggesting the systemic reabsorption of mesenteric-derived lymphatic fl uid leads to neutrophil priming and is associated with distant organ failure. They went on to describe a potential ischemia-reperfusion injury, which occurred when progressively increasing IAP leads to mesenteric ischemia followed by rapid reperfusion with surgical decompression [ 16 ]. Several studies have shown that IAH, even when occult, promotes signifi cant mesenteric ischemia [ 17 ].…”