Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

Abstract

Background: Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome.

Methods: A systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed.

Results: A total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH₂O; p < 0.001) and a mean increase in P/F ratio (70.4 ± 49.4; p < 0.001) and UO (95.3 ± 105.3 ml/h; p < 0.001). In children, there was a significant increase in MAP (20.0 ± 2.3 mmHg; p = 0.006), P/F ratio (238.2; p < 0.001), and UO (2.88 ± 0.64 ml/kg/h; p < 0.001) and a decrease in CVP (7 mmHg; p = 0.016) and PIP (9.9 cmH₂O; p = 0.002). The overall mortality rate was 49.7% in adults and 60.8% in children following decompressive laparotomy.

Conclusions: Decompressive laparotomy resulted in a significantly lower IAP and had beneficial effects on hemodynamic, respiratory, and renal parameters. Mortality after decompressive laparotomy remains high in both adults and children.

Keywords: Abdominal compartment syndrome; Decompressive laparotomy; Hemodynamic recovery; Intensive care; Kidney recovery; Mortality rate; Multiple organ failure; Respiratory recovery.

Fig. 1

Study selection flowchart

Fig. 2

Funnel plot of all articles included in this study

Fig. 3

Effect of decompressive laparotomy on IAP in adult patients. The baseline intra-abdominal pressure is shown as a dark gray column. The light gray column represents the postoperative intra-abdominal pressure. *Articles reporting on grade IV ACS. IAP Intra-abdominal pressure, DL Decompressive laparotomy

Fig. 4

Effect of decompressive laparotomy on mortality rate in adults, according to year of publication

Fig. 5

Time to decompressive laparotomy and mortality rate in adults

Fig. 6

Effect of decompressive laparotomy on organ function parameters in children. Preoperative IAP is shown as a light gray column. The dark gray column represents the postoperative intra-abdominal pressure. *HR and P/F ratio are shown as one-tenth of actual value. IAP Intra-abdominal pressure, HR Heart rate, MAP Mean arterial pressure, CVP Central venous pressure, PIP Peak inspiratory pressure, PEEP Positive end-expiratory pressure, P/F ratio Ratio of partial pressure arterial oxygen and fraction of inspired oxygen, UO Urinary output