Abstract
BackgroundAn open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery. However, abdominal wall retraction relieves delays and complicates abdominal wall closure. The principle of the newly fascia preserving device (FPD) is the application of anteriorly directed traction on both fascial edges over an external support through a longitudinal beam to relieve increased abdominal pressure and prevent fascial retraction.MethodsTwelve pigs were randomly divided into two groups. Both groups underwent midline laparotomy under general anesthesia. Group one was treated with the new device, group two served as controls. The tension for closing the abdominal fascia was measured immediately after laparotomy as well as at 24 and 48 h. Vital parameters and ventilation pressure were recorded. Post mortem, all fascial tissues were histologically examined.ResultsAll pigs demonstrated increases in abdominal circumference. In both groups, forces for closing the abdomen increased over the observation period. Concerning the central closing force after 24 h we saw a significant lower force in the FPD group (14.4 ± 3 N) vs. control group (21.6 ± 5.7 N, p < 0.001). By testing the main effects using an ANOVA analysis we found a significant group related effect concerning closing force and abdominal circumference of the FDP-group vs. control group (p < 0.001; p < 0.001). The placement of the device on chest and pelvis did not influence vital parameters and ventilation pressure. Histologic exam detected no tissue damage.ConclusionsThis trial shows the feasibility to prevent fascial retraction during the open abdomen by using the new device. Thus, it is expected that an earlier closure of the abdominal wall will be possible, and a higher rate of primary closure will be attained.
Highlights
An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery e.g. after trauma [1]
Good results have been attained by vacuum therapy combined with fascial traction, whether with interpolated mesh or for example, ABRA® abdominal wall closure [7]
The fascial edges are pulled anteriorly relative to the thorax and pelvis
Summary
An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery. An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery e.g. after trauma [1]. The increased intraabdominal volume in the presence of visceral swelling requires a large area of the abdomen to be left open after laparotomy to prevent pressure-induced necrosis of the organs and tissues [2]. In this situation, the tension from the musculature acting on the abdominal wall.
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