The ‘sandwich technique’ in the management of the open abdomen

Schein, Moshe; Saadia, Roger; Jamieson, J. R.; Decker, G

doi:10.1002/bjs.1800730514

Cited by 91 publications

(54 citation statements)

References 4 publications

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“…Necrosectomy was not performed. The abdomen was left open with a ‘sandwich’ consisting of a synthetic mesh (Marlex) and adhesive drape [6]. The postoperative IAP at 1, 6, 12, and 24 h ranged between 0 and 10 cm H 2 O. Urinary output picked up immediately after the operation to more than 100 ml/h; vasopressors were stopped within 72 h, and the patient extubated after a week.…”

Section: Case Reportsmentioning

confidence: 99%

Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?

et al. 2002

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Background: The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome (ACS), which is associated with the acute pancreatitis. Methods: We present our recent experience with three patients suffering from severe acute pancreatitis. The three developed intra-abdominal hypertension (IAHT) and clinical ACS, which necessitated abdominal decompression and a laparostomy. One patient survived. Conclusions: The notion that patients with severe acute pancreatitis may develop ACS, which necessitate emergency abdominal decompression, has been ignored by current surgical literature. Only increased awareness to the syndrome of IAHT-ACS in acute pancreatitis and transvesical measurement of intra-abdominal pressure will reveal its prevalence and significance.

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Section: Case Reportsmentioning

confidence: 99%

Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?

et al. 2002

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“…These include the 'Bogota Bag', towel-clip skin only closure, 12 synthetic mesh, both absorbable 2,8,13 and non-absorbable, 10 the 'sandwich' dressing, 14 various 'vacuum pack' derivatives [15][16][17] and silicone elastomer sheeting. 18 The variety of techniques described suggests that each may have limitations in use.…”

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confidence: 99%

Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

Wilde

Loudon

2007

annals

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INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients.PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission.CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite ® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality. KEYWORDS Laparostomy -Temporary abdominal closure (TAC) -Abdominal compartment syndrome (ACS)

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“…Currently, a passive 'sandwich' pack dressing is more commonly recommended 186 or where available, a Wittman Dynamic Patch TM (Star Surgical Inc, Wisconsin USA) or Abra ® dynamic closure system (Canica design, Ontario CA) may be used permitting patch advancement at the bedside. 187 The negative pressure vacuum-VAC closure device (KCI International, San Antonio TX) has had considerable recent success as a first-up method of open wound management 188 with selected alternatives including temporary absorbable and non-absorbable forms of mesh, 189,190 silos 191 and 'zipper-style' techniques. [192][193][194] The sandwich suction dressing is the easiest and cheapest method to employ being a forerunner of the VAC technique with placement of large adhesive drapes into the paracolic gutter under suction drains.…”

Section: Surgical Decompressionmentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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The ‘sandwich technique’ in the management of the open abdomen

Cited by 91 publications

References 4 publications

Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?

Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?

Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

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