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Review
. 2018 Feb 2:13:7.
doi: 10.1186/s13017-018-0167-4. eCollection 2018.

The open abdomen in trauma and non-trauma patients: WSES guidelines

Federico Coccolini  1 , Derek Roberts  2 , Luca Ansaloni  1 , Rao Ivatury  3 , Emiliano Gamberini  4 , Yoram Kluger  5 , Ernest E Moore  6 , Raul Coimbra  7 , Andrew W Kirkpatrick  2 , Bruno M Pereira  8 , Giulia Montori  1 , Marco Ceresoli  1 , Fikri M Abu-Zidan  9 , Massimo Sartelli  10 , George Velmahos  11 , Gustavo Pereira Fraga  8 , Ari Leppaniemi  12 , Matti Tolonen  12 , Joseph Galante  13 , Tarek Razek  14 , Ron Maier  15 , Miklosh Bala  16 , Boris Sakakushev  17 , Vladimir Khokha  18 , Manu Malbrain  19 , Vanni Agnoletti  4 , Andrew Peitzman  20 , Zaza Demetrashvili  21 , Michael Sugrue  22 , Salomone Di Saverio  23 , Ingo Martzi  24 , Kjetil Soreide  25   26 , Walter Biffl  27 , Paula Ferrada  3 , Neil Parry  28 , Philippe Montravers  29 , Rita Maria Melotti  30 , Francesco Salvetti  1 , Tino M Valetti  31 , Thomas Scalea  32 , Osvaldo Chiara  33 , Stefania Cimbanassi  33 , Jeffry L Kashuk  34 , Martha Larrea  35 , Juan Alberto Martinez Hernandez  36 , Heng-Fu Lin  37 , Mircea Chirica  38 , Catherine Arvieux  38 , Camilla Bing  39 , Tal Horer  40 , Belinda De Simone  41 , Peter Masiakos  42 , Viktor Reva  43 , Nicola DeAngelis  44 , Kaoru Kike  45 , Zsolt J Balogh  46 , Paola Fugazzola  1 , Matteo Tomasoni  1 , Rifat Latifi  47 , Noel Naidoo  48 , Dieter Weber  49 , Lauri Handolin  50 , Kenji Inaba  51 , Andreas Hecker  52 , Yuan Kuo-Ching  53 , Carlos A Ordoñez  54 , Sandro Rizoli  55 , Carlos Augusto Gomes  56 , Marc De Moya  57 , Imtiaz Wani  58 , Alain Chichom Mefire  59 , Ken Boffard  60 , Lena Napolitano  61 , Fausto Catena  62
Affiliations
Review

The open abdomen in trauma and non-trauma patients: WSES guidelines

Federico Coccolini et al. World J Emerg Surg. .

Abstract

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

Keywords: Biological; Closure; Fistula; Guidelines; Intra-abdominal infection; Laparostomy; Mesh; Non-trauma; Nutrition; Open abdomen; Pancreatitis; Peritonitis; Re-exploration; Reintervention; Synthetic; Technique; Timing; Trauma; Vascular emergencies.

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Conflict of interest statement

Not applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
WSACS grading of intra-abdominal hypertension (IAH) (IAP intra-abdominal pressure, ACS abdominal compartment syndrome) [4]
Fig. 2
Fig. 2
Open Abdomen classification according to Björck et al. [147]
See this image and copyright information in PMC

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MeSH terms