Negative Pressure Therapy for Management of the Open Abdomen

Abstract

Indications for the open abdomen include damage-control laparotomy, abdominal compartment syndrome (ACS), severe peritonitis, or need for second-look laparotomy to evaluate potentially compromised bowel (Fig. 33.1). In these situations, temporary abdominal closure (TAC) is performed. Contemporary techniques for TAC utilize negative pressure therapy and are designed to prevent evisceration, remove fluid from the abdominal cavity, and preserve abdominal domain. There are commercially available NPT devices, such as the ABThera© system, for TAC. Based on institutional availability, an alternative technique, called a Barker vacuum pack, can be constructed from local supplies. These systems have different mechanical properties. The ABThera© system maintains a more consistent negative pressure in the periphery and is more effective in removing peritoneal fluid than the Barker method. There is evidence that the ABThera© system is associated with better survival, decreased complications, and shorter time to definitive fascial closure than the improvised Barker vacuum pack.