Temporary Abdominal Closure in the Critically Ill Patients with an Open Abdomen
The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag). The study population comprised of 11 (57.9%) male and 8 (42.1%) female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9%) patients, subjective judgment that the fascia closure is too tight in 6 (31.6%) patient's damage control surgery in one patient (5.3%) and development of abdominal compartment surgery in one patient (5.3%). Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4%) patients, post operative intestinal fistula in 4 (21.1%) patients, post traumatic intra abdominal bleeding in 3 (15.8%) patients and intestinal obstructions in 3 (15.8%) patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1) early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3%) late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54) months. Currently 10 patients (52.6%) are alive at a follow up of 45 (range 1-94) months. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogotá bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage.
Burch JM, Ortiz VB, Richardson RJ, et al. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 1992;215(5):476-84.
Tremblay LN, Feliciano DV, Schmidt J, et al. Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg 2001;182(6):670-5.
Sherck J, Seiver A, Shatney C, et al. Covering the "open abdomen": a better technique. Am Surg 1998;64(9):854-7.
Smith PC, Tweddell JS, Bessey PQ. Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma 1992;32(1):16-20.
Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 1994;219(6):643-50.
Hedderich GS, Wexler MJ, McLean AP, et al. The septic abdomen: open management with Marlex mesh with a zipper. Surgery 1986;99(4):399-408.
Nagy KK, Fildes JJ, Mahr C, et al. Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg 1996;62(5):331-5.
Porter JM. A combination of Vicryl and Marlex mesh: a technique for abdominal wall closure in difficult cases. J Trauma 1995;39(6):1178-80.
Foy HM, Nathens AB, Maser B, Mathur S, Jurkovich GJ. Reinforced silicone elastomer sheeting, an improved method of temporary abdominal closure in damage control laparotomy. Am J Surg 2003;185(5):498-501.
Boyd WC. Use of Marlex mesh in acute loss of the abdominal wall due to infection. Surg Gynecol Obstet 1977;144(2):251-2.
Schein M, Saadia R, Decker GG. The open management of the septic abdomen. Surg Gynecol Obstet 1986;163(6):587-92.
Schein M, Saadia R, Freinkel Z, et al. Aggressive treatment of severe diffuse peritonitis: a prospective study. Br J Surg 1988;75(2):173-6.
Schein M, Hirshberg A, Hashmonai M. Current surgical management of severe intraabdominal infection. Surgery1992;112(3):489-96.
Offner PJ, de Souza AL, Moore EE, et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma. Arch Surg 2001;136(6):676-81.
Mattox KL. Introduction, background, and future projections of damage control surgery. Surg Clin North Am 1997;77(4):753-9.
Navsaria PH, Bunting M, Omoshoro-Jones J, et al. Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg 2003;90(6):718-22.
Mughal MM, Bancewicz J, Irving MH. 'Laparostomy': a technique for the management of intractable intraabdominal sepsis. Br J Surg 1986;73(4):253-9.
Rotstein OD, Avery NB. Peritonitis and intra-abdominal abscesses. In: Wilmore DW, Cheung LY, Harken AH, et,al, editors. ACS Surgery: Principles and Practice. 2nd edition. New York: Soper WebMD Corporation; 2002: p.1254-5.
Howard CA, Turner WW Jr. Successful treatment of early, postoperative, necrotizing infection of the abdominal wall. Crit Care Med 1989;17(6):586-7.
Girard S, Sideman M, Spain DA. A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities. Am J Surg 2002;184(2):166-7.
Garner GB, Ware DN, Cocanour CS, et al. Vacuumassisted, wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg 2001;182(6):630-8.
Hirshberg A, Walden R. Damage control for abdominal trauma. Surg Clin North Am 1997;77(4):813-20.
Moore EE. Thomas G. Orr Memorial Lecture. Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg 1996;172(5):405-10.
Raeburn CD, Moore EE, Biffl WL, et al. The abdominal compartment syndrome is a morbid complication ofpostinjury damage control surgery. Am J Surg 2001;182(6):542-6.
Eiseman B, Moore EE, Meldrum DR, et al. Feasibility of damage control surgery in the management of military combat casualties. Arch Surg 2000;135(11):1323-7.
Moore EE, Burch JM, Franciose RJ, et al. Staged physiologic restoration and damage control surgery. World J Surg 1998;22(12):1184-90.
Mc Gonigal MD, Weigelt JA. Reoperation after severe acute trauma. In: MC Quarrie DG, Humphery EW, Louie JS, editors. Reoperative general surgery. 2nd ed. St. Louis, Mo: Mosby; 1997; p. 524-9.
Fabian TC, Croce MA, Minard G, et al. Current issues in trauma. Curr Probl Surg 2002;39(12):1160-244.
Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 1986;121(8):954-60.
Bender JS, Bailey CE, Saxe JM, Ledgerwood AM, Lucas CE. The technique of visceral packing: recommended management of difficult fascial closure in trauma patients. J Trauma 1994;36(2):182-5.
Mastboom WJ, Kuypers HH, Schoots FJ, et al. Smallbowel perforation complicating the open treatment of generalized peritonitis. Arch Surg 1989;124(6):689-92.
Ivatury RR, Diebel L, Porter JM, et al. Intra-abdominal Hypertension and the Abdominal Compartment Syndrome. Surg Clin North Am 1997;77(4):783-800.
Ghimenton F, Thomson SR, Muckart DJ, et al. Abdominal content containment: practicalities and outcome. Br J Surg 2000;87(1):106-9.
Mayberry JC, Mullins RJ, Crass RA, et al. Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. Arch Surg 1997;132(9):957-61.
Burch JM, Moore EE, Moore FA, et al. The abdominal compartment syndrome. Surg Clin North Am 1996;76(4):833-42.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.