Abstract
Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.
Highlights
The open abdomen is associated with significant morbidity and mortality and its management poses a formidable challenge
Ill patients with underlying intraabdominal hypertension due to sepsis or injury are often managed with a damage control laparotomy (DCL), which involves the minimum intervention necessary to save the patient’s life
The decline could be indicated by increasing lactate, which is indicative of worsening shock, increasing acidosis or coagulopathy, or an ongoing transfusion or vasopressor requirement
Summary
The open abdomen is associated with significant morbidity and mortality and its management poses a formidable challenge. The open abdomen is often complicated by peritoneal contamination, intra-abdominal abscess, fluid losses, ileus, evisceration, and long-term sequelae such as ventral hernia and enterocutaneous fistula Management of these wounds and of the patient can often be challenging [3]. The first goal is delayed primary fascial closure; many surgeons do not attempt primary fascial closure at all Often, they use mesh and/or granulation tissue with splitthickness skin grafting to close the abdominal wound. In case of persistent visceral edema, loss of domain, or lateral retraction, the only option is to close the wound with mesh or granulation tissue with split-thickness skin grafting In doing so, they create a “planned ventral hernia,” which can be corrected at a later stage [5]
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