Reinforced silicone elastomer sheeting, an improved method of temporary abdominal closure in damage control laparotomy

Damage control laparotomy has become an accepted practice in trauma surgery. A number of methods leading to delayed primary closure of the abdomen have been advocated; complications are recognized with all these methods. The approach to staged repair using the Wittmann patch (Star Surgical Inc., Burlington, WI) combines the advantages of planned relaparotomy and open management, while minimizing the rate of complications. The authors hypothesized that use of the Wittmann patch would lead to a high rate of delayed primary closure of the abdomen. The patch consists of two sheets sutured to the abdominal fascia, providing for temporary closure. Advancement of the patch and abdominal exploration can be done at bedside. When the fascial edges can be reapproximated without tension, abdominal closure is performed. Twenty-six patients underwent staged abdominal closure during the study period. All were initially managed with intravenous bag closure. Eighty-three per cent (20 of 24) went on to delayed primary closure of the abdomen, with a mean time of 13.1 days from patch placement to delayed primary closure. The rate of closure using the Wittmann patch is equivalent to other commonly used methods and should be considered when managing patients with abdominal compartment syndrome or severe abdominal trauma.

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Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

The American Surgeon ◽

10.1177/000313480507100309 ◽

2005 ◽

Vol 71 (3) ◽

pp. 219-224 ◽

Cited By ~ 12

Author(s):

JosÉ A. Montalvo ◽

JosÉ A. Acosta ◽

Pablo RodrÍguez ◽

Kathia Alejandro ◽

AndrÉs SÁrraga

Keyword(s):

Surgical Complications ◽

Causes Of Death ◽

Surgical Complication ◽

Damage Control ◽

Multiple Logistic Regression Analysis ◽

Hypovolemic Shock ◽

Damage Control Surgery ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

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Difference Between Delayed Anastomosis and Early Anastomosis in Damage Control Laparotomy Affecting the Infusion Volume and NPWT Output volume: Is Infusion Restriction Necessary in Delayed Anastomosis? A Single-Center Retrospective Analysis

10.21203/rs.3.rs-772713/v1 ◽

2021 ◽

Author(s):

Yohta Tanahashi ◽

Hisaho Sato ◽

Akiko Kawakami ◽

Shusaku Sasaki ◽

Yu nishinari ◽

...

Keyword(s):

Retrospective Analysis ◽

Emergency Surgery ◽

Damage Control ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Artificial Anus ◽

Single Center ◽

Damage Control Laparotomy ◽

Second Look ◽

Output Volume

Abstract Background: Delayed anastomosis is a treatment strategy used in damage control laparotomy (DCL). During temporary abdominal closure (TAC) with DCL, infusion volume, and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure (PFC). The same may also hold true for anastomosis. The aim of this research is to evaluate whether the difference between early anastomosis and delayed anastomosis in DCL is related to infusion volume and NPWT output volume.Methods: This single-center retrospective analysis targeted patients managed with TAC during emergency surgery for trauma or intra-abdominal sepsis between January 2011 and December 2019. It included patients who underwent repair/anastomosis/artificial anus construction in the first surgery and patients who underwent intestinal resection in the first surgery followed by delayed anastomosis with no intestinal continuity. The main outcomes were infusion volume, NPWT output volume and complications.Results: One hundred nine patients who underwent emergency surgery were evaluated. Seventy-three patients were managed with TAC using NPWT. In 16 patients with early anastomosis and 21 patients with delayed anastomosis, there was no difference in the infusion volume (p=0.2318) or NPWT output volume (p=0.7128) 48 hours after surgery. Additionally, there was no difference in the occurrence of surgical site infection (p=0.315) and suture failure (p=0.8428). During the second-look surgery after 48 hours, the anastomosis was further postponed for 48% of the patients who underwent delayed anastomosis. There was no difference in the infusion volume (p=0.0783) up to the second-look surgery between the patients whose delayed anastomosis was postponed and those who underwent delayed anastomosis, but there was a tendency toward a large NPWT output volume (p=0.024) in the postponed delayed anastomosis group. Anastomosis and PFC were achieved for all patients whose delayed anastomosis was postponed.Conclusions: The presence or absence of anastomosis during TAC management does not affect NPWT output volume. Delayed anastomosis may be managed with the same infusion volume as that used for early anastomosis. There is also the option of postponing anastomosis if the planned delayed anastomosis is complicated.Trial RegistrationThe retrospective protocol of this study was approved by our institutional review board (MH2018-611).

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The open abdomen

10.1093/med/9780199682874.003.0102 ◽

2021 ◽

pp. 1179-1184

Author(s):

Omar A. Khan ◽

Emma Rose McGlone ◽

Marcus Reddy

Keyword(s):

Negative Pressure ◽

Open Abdomen ◽

Damage Control ◽

Damage Control Surgery ◽

Temporary Abdominal Closure ◽

Systemic Complications ◽

Advantages And Disadvantages ◽

Abdominal Closure ◽

Local And Systemic Complications ◽

Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

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Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

Gastroenterology Research and Practice ◽

10.1155/2016/2073260 ◽

2016 ◽

Vol 2016 ◽

pp. 1-15 ◽

Cited By ~ 12

Author(s):

Qian Huang ◽

Jieshou Li ◽

Wan-yee Lau

Keyword(s):

Damage Control ◽

Synthetic Mesh ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Fascial Defect ◽

Components Separation ◽

Abdominal Closure ◽

Combined Use ◽

Early Primary ◽

Primary Fascial Closure

Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x155446 ◽

2007 ◽

Vol 89 (1) ◽

pp. 57-61 ◽

Cited By ~ 15

Author(s):

JM Wilde ◽

MA Loudon

Keyword(s):

Critically Ill ◽

Damage Control ◽

Injured Patient ◽

Damage Control Surgery ◽

Traumatic Experience ◽

Fascial Closure ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Operative Severity Score

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.

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Challenges in the Management of the Open Abdomen

ICU Director ◽

10.1177/1944451612469628 ◽

2012 ◽

Vol 4 (1) ◽

pp. 33-39 ◽

Cited By ~ 1

Author(s):

David J. Worhunsky ◽

Gregory Magee ◽

David A. Spain

Keyword(s):

Open Abdomen ◽

Damage Control ◽

Original Description ◽

Fascial Closure ◽

Critically Ill Patient ◽

Temporary Abdominal Closure ◽

Recurrence Rates ◽

Abdominal Closure ◽

Intra Abdominal Infection ◽

Temporary Closure

First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogotá bag to vacuum-assisted techniques; a combined technique of sequential fascial closure with vacuum assistance has recently been shown to result in 100% fascial approximation. In situations where fascial closure is unattainable, temporary coverage with a skin graft may be employed, followed by late abdominal closure via complex abdominal herniorrhaphy. Even using advanced methods such as component separation or a “pork sandwich” technique, the complication and recurrence rates remain high. A careful understanding of the indications, optimal management, and potential complications of the open abdomen is necessary to limit its overuse and ultimately reduce some of the challenges associated with it.

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Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis

World Journal of Emergency Surgery ◽

10.1186/s13017-018-0204-3 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 5

Author(s):

Parker Hu ◽

Rindi Uhlich ◽

Frank Gleason ◽

Jeffrey Kerby ◽

Patrick Bosarge

Keyword(s):

Retrospective Analysis ◽

Damage Control ◽

Damage Control Surgery ◽

Temporary Abdominal Closure ◽

Abdominal Closure

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Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Surgical Innovation ◽

10.1177/1553350619857561 ◽

2019 ◽

Vol 26 (6) ◽

pp. 656-661 ◽

Cited By ~ 5

Author(s):

Antonio Brillantino ◽

Mauro Andreano ◽

Michele Lanza ◽

Vito D’Ambrosio ◽

Ferdinando Fusco ◽

...

Keyword(s):

Diverticular Disease ◽

Control Strategy ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Damage Control ◽

Morbidity Rate ◽

Diffuse Peritonitis ◽

Temporary Abdominal Closure ◽

Wound Therapy ◽

Abdominal Closure

Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients’ conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann’s procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann’s procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.

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