Temporary abdominal closure techniques in open abdomen: preliminary data of international register of open abdomen (IROA): patient enrollment is still ongoing

2017 ◽  
pp. 1
Author(s):  
Giulia Montori ◽  
Federico Coccolini ◽  
Paola Fugazzola ◽  
Marco Ceresoli ◽  
Francesco Salvetti ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Open Abdomen ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Patient Enrollment

The open abdomen

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.

Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

2021 ◽  
Author(s):  
Vincenzo Pappalardo ◽  
Stefano Rausei ◽  
Vincenzo Ardita ◽  
Luigi Boni ◽  
Gianlorenzo Dionigi
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Secondary Peritonitis ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Primary Fascial Closure

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Application of pie-crusting technique to facilitate closure of open abdomen after decompressive laparotomy

2021 ◽  
Vol 14 (8) ◽  
pp. e244219
Author(s):  
Thomas J Martin ◽  
Tareq Kheirbek
Keyword(s):  
Abdominal Wall ◽  
Primary Closure ◽  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Skin Grafting ◽  
Temporary Abdominal Closure ◽  
Pressure Therapy ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Split Thickness Skin Grafting

We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall ‘pie-crusting’, or tension-releasing multiple skin incisions, technique.

scholarly journals Open abdomen treatment with negative pressure wound therapy at department for abdominal surgery, UCC Maribor: Our experiences and results

2016 ◽  
Vol 63 (1) ◽  
pp. 121-123
Author(s):  
Bojan Krebs
Keyword(s):  
Abdominal Surgery ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Pressure System ◽  
Abdominal Closure ◽  
Primary Surgery ◽  
Better Than

Introduction: With the development of modern surgery we often come to situation where, after the procedure, closing of abdomen is not feasable. There are many techniques of temporary abdominal closure but best results today are achieved with negative pressure system. Despite widespread use, there is still a lot of confusion regarding the indications, the application of the technique and complications. Objective: The aim of our study was to explain the system with negative pressure and show our experience and results in the treatment of patients with it. Methods: We retrospectively analyzed the data of all patients from 2011 to 2014 which were treated with negative pressure. We were interested in following data: the date of the primary surgery, diagnosis, date and indication for use of the system with negative pressure, the number of system changes, type of final closure of the abdominal cavity and the date of discharge or death. Results: Between 2011 and 2014 we treated 52 patients, 32 men and 20 women with a system with negative pressure. The average age of the patients was 67 years (25 - 85 years). 25 patients were operated on electively and due to complications we used the system for negative pressure. In 27 patients we used negative pressure system after the primary emergency procedure. Mortality was 50 %. Conclusion: The treatment of the open abdomen with negative pressure is an essential part of modern abdominal surgery. Survival after treatment with negative pressure is better than with other techniques of temporary abdominal closure. Man must take in consideration problems with fascial closure and big postoperative hernias wich demand further operations.

Complications and Mortality Associated with Temporary Abdominal Closure Techniques: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 83 (2) ◽  
pp. 191-216 ◽  
Author(s):  
Adam Cristaudo ◽  
Scott Jennings ◽  
Ronny Gunnarsson ◽  
Alan Decosta
Keyword(s):  
Systematic Review ◽  
Open Abdomen ◽  
Meta Analysis ◽  
Final Analysis ◽  
Fascial Closure ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Central Register

Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov. All studies describing TAC technique use in the open abdomen were eligible for inclusion. Data were analyzed per TAC technique in the form of a meta-analysis. A total of 225 articles were included in the final analysis. A meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure [mean difference (MD): 35% ± 23%; P = 0.0044]. A subsequent meta-analysis involving all included studies confirmed its superiority across outcomes for definitive fascial closure (MD: 19% ± 3%; P < 0.0001), perioperative (MD: -4.0% ± 2.4%; P = 0.0013) and in-hospital (MD: -5.0% ± 2.9%; P = 0.0013) mortality, entero-atmospheric fistula (MD: 22.0% ± 1.8%; P = 0.0041), ventral hernia (MD: -4.0% ± 2.4%; P = 0.0010), and intra-abdominal abscess (MD: -3.1% ± 2.1%; P = 0.0044). Therefore, it was concluded that NPWT with continuous fascial traction is superior to NPWT alone.

Challenges in the Management of the Open Abdomen

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 33-39 ◽  
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.

Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen

2004 ◽  
Vol 188 (3) ◽  
pp. 301-306 ◽  
Author(s):  
Thomas R. Howdieshell ◽  
Charles D. Proctor ◽  
Erez Sternberg ◽  
Jorge I. Cué ◽  
J.Sheppard Mondy ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

scholarly journals DEVELOPMENT OF OPEN ABDOMEN DEVICE BASED ON BIODESIGN METHODOLOGY

2021 ◽  
Vol 1 ◽  
pp. 1253-1262
Author(s):  
Manuela Sierra ◽  
Salín Pereira ◽  
Juan Felipe Isaza ◽  
Iván Darío Montoya ◽  
Christian Andrés Diaz ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Innovation Process ◽  
Physical And Mechanical Properties ◽  
Control Group ◽  
Abdominal Pressure ◽  
Temporary Abdominal Closure ◽  
New Device ◽  
Abdominal Closure ◽  
Healthcare Needs ◽  
And Control

AbstractOpen Abdomen (OA) therapy, is purposely leaving the fascial edges of the abdomen un-approximated after a laparotomy. During the OA therapy, there must be a temporary abdominal closure (TAC) device installed in the patient to achieve abdominal closure gradually without affecting its safety. However, the actual TAC devices have some gaps in terms of functionality or usability, therefore a new device is proposed. Intending to design a usable and functional technique for patients all over the world, the BioDesign Innovation Process was used. This iterative methodology focuses on healthcare needs, invention, and concept development with three main phases: Identify, Invent and Implement. At the end of these phases, the team successfully developed two new abdominal closure techniques that fill in the gaps of functionality and usability, using a simulator that realistically mimicked the physical and mechanical properties of an open abdomen. In terms of functionality, the novel techniques showed safe installation, operational security, secure grip, low invasiveness and control of intra-abdominal pressure. In terms of usability, the devices showed better results in efficiency, effectiveness and easy re-exploration than the control group.

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