The open abdomen, indications, management and definitive closure

Abstract

The indications for Open Abdomen (OA) are generally all those situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS). In fact all those involved in care of a critically ill patient should in the first instance think how to prevent IAH and ACS. In case of ACS goal directed therapy to achieve early opening and early closure is the key: paradigm of closure shifts to combination of therapies including negative pressure wound therapy and dynamic closure, in order to reduce complications and avoid incisional hernia. There have been huge studies and progress in survival of critically ill trauma and septic surgical patients: this in part has been through the great work of pioneers, scientific societies and their guidelines; however future studies and continued innovation are needed to better understand optimal treatment strategies and to define more clearly the indications, because OA by itself is still a morbid procedure.

Keywords: Closure; Management; Open abdomen; Pancreatitis; Peritonitis; Trauma.

Fig. 1

Schematic flow-chart for the treatment of the open abdomen

Fig. 2

Synthetic mesh sutured to the fascial edges to maintain the traction and prevent the fascial retraction with a plastic sheet posed under in direct contact with the intrabdominal content to protect the bowel

Fig. 3

Aspiration system could be placed over the eventual continuous traction system