Surgical Strategies for Management of the Open Abdomen

Regner, Justin L.; Kobayashi, Leslie; Coimbra, Raúl

doi:10.1007/s00268-011-1203-7

Cited by 138 publications

(135 citation statements)

References 140 publications

(106 reference statements)

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“…2 A variety of different techniques for TAC have been used in the past, including the Bagota bag, mesh, Wittmann patch and Barker vacuum pack. A systematic review and prospective observational trial have demonstrated that the ABThera Open Abdomen Negative Pressure Therapy System (KCI USA) may be the most effective TAC method.…”

mentioning

confidence: 99%

“…The ABThera, when used alone, fails to reapproximate the fascia in about 30% of patients with an open abdomen. [2][3][4] Failure to close the fascia primarily results in an increased risk of enteroatmospheric fistula, requirement for skin grafting of the visceral mass and a large ventral hernia. Furthermore, early primary closure of the open abdomen has been associated with improved patient survival.…”

mentioning

confidence: 99%

“…5 The use of mechanical traction with sequential suturing and mesh imbrication in conjunction with the ABThera have been shown to significantly increase primary fascial closure rates to approximately 90%. 2,[6][7][8][9] The abdominal reapproximation anchor system (ABRA; Canica Design Inc.) is a dynamic closure system that uses elastomers through the full thickness of the abdominal wall that slowly pull the fascia together under continuous variable tension. It is easier to manage than mesh imbrication or sequential suturing and allows for the abdominal wall to oscillate with patient movement and breathing.…”

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confidence: 99%

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Management of the open abdomen using combination therapy with ABRA and ABThera systems

Mukhi

Minor

2014

Can J Surg

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Management of the open abdomen using combination therapy with ABRA and ABThera systems

Mukhi

Minor

2014

Can J Surg

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“…13,14 The open abdomen procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. 15 Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of open abdomen in order to be able to use it in the right patient at the right time. However, the use of this technique has been described in very modern contests, but only few Authors relate about their experience in poor countries where human and technical resources are limited.…”

Section: Discussionmentioning

confidence: 99%

Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

et al. 2017

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Laparostomy is a surgical technique enabling the surgeon to leave abdominal fascial edges opened after a laparotomy. This is a useful tool that can be very important in patients with intraabdominal hypertension. Open abdomen indications are: trauma, severe abdominal sepsis, intestinal infarction, vascular surgery and when the surgeon cannot close the abdomen due to high intra abdominal pressure in order to avoid abdominal compartment syndrome or in case of a second look in order to evaluate the conditions of the abdomen (and particularly of the gut). We used this technique in a low income country for a patient with intestinal obstruction where performing a primary anastomosis during the first operation was at high risk of leakage.A middle-aged woman was admitted in Pope John's Hospital -Aber, Uganda for abdominal pain and intestinal obstruction (IO) symptoms. A laparotomy found a tract of small gut necrotic and twisted under a single adhesion. The small gut above the volvulus was dilated for the obstruction created by the adhesion. We decided to excise the necrotic intestine and leave the abdomen open for a second look and delayed anastomosis and closure. The managing of the IO was conducted by inserting a big Foley catheter in the proximal intestine to drain its enteric content in a similar fashion to a guided external fistula.Open abdomen is a very important technique, relatively new, that can impact positively in treating some surgical patients even in rural hospitals and in the absence of Intensive Care Unit. A simple trick can solve successfully the IO due to the volvulus. Laparostomy should be spread more in African and low-income countries. Case ReportA 42(?)-year old woman came to Aber Hospital at around 7:00 p.m. and was admitted in October 2015 to the surgical ward complaining severe abdominal pain, she was not passing stools and flatus for the past 5 days and she had no history of previous surgeries. The patient was hemodynamically stable, although slightly tachicardic (BP 100/70, HR 100 bpm). Clinically she presented with severe abdominal distension and signs of peritonitis. Rectal exploration was carried out at hospital admission showing empty rectus. We tried to manage this case conservatively by passing a rectal tube thinking it could have been a sigmoid volvulus, very frequent in African communities but after a plain abdominal XR we realized the distension was coming from the small gut. Blood tests showed a mild leukocytosis, normal Hb and PLT. The patient started resuscitation fluids, IV antibiotics, and pain relief, we passed a NGT and urinary catheter. An explorative laparotomy was planned the following day: despite she was slightly peritonitic at presentation, it was impossible to set up the theatre and perform the operation sooner due to logistic deficiency. The NGT output before the operation was about 100 mls and urine output about 1500 mls. The operation was undertaken the following morning, as soon as it was possible to arrange the theatre (around 8:00 a.m.), and the patient's vi...

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“…Hemorrhagic shock and required crystalloid and blood product resuscitation result in visceral edema often preventing primary fascial closure of the abdominal wall [3]. As a result, definitive abdominal wall repair is preceded by a period of temporary abdominal wall closure [4] [5]. If early primary fascial closure is not practical or feasible, techniques have been reported for management of the open abdominal defect including closure with an absorbable mesh to provide a scaffold for visceral granulation tissue formation and cutaneous coverage by split-thickness skin graft (STSG) [6] [7].…”

Section: Introductionmentioning

confidence: 99%

Investigation of Open Abdomen Visceral Skin Graft Revascularization and Separation from Peritoneal Contents

Clark¹,

Coffman²,

Brandenburg³

et al. 2018

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Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling; and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.

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Surgical Strategies for Management of the Open Abdomen

Cited by 138 publications

References 140 publications

Management of the open abdomen using combination therapy with ABRA and ABThera systems

Management of the open abdomen using combination therapy with ABRA and ABThera systems

Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

Investigation of Open Abdomen Visceral Skin Graft Revascularization and Separation from Peritoneal Contents

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