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| The management of the open abdomen continues to pose a challenge for surgeons. After surgical exploration for abdominal trauma, operative misadventure, or relief of abdominal compartment syndrome, definitive closure of the abdominal fascia and abdominal wall immediately following laparotomy may be technically impossible.Alternatively, the abdomen may need to remain open to allow access for re-operation and time for decompression of the abdomen.Multiple techniques for temporary abdominal closure have been described in the literature. To better understand the current treatment of the open abdomen, an expert panel of surgeons convened to review the literature and current practices in managing the open abdomen. The panel reviewed the reasons for the increasing number of open abdomen procedures as well as each treatment method in the context of evidence-based medicine. In addition, panel members shared their experiences using various techniques for treating the open abdomen.The use of the open abdomen as a surgical option has increased in recent years. Benefits of maintaining an open abdomen include ease of re-exploration, control of abdominal contents, reduction of the risk of intra-abdominal hypertension and abdominal compartment syndrome, and fascial preservation for closure of the abdominal wall. The prolonged exposure of abdominal viscera can result in high rates of complications, including infection, sepsis, and fistula formation. A number of techniques have been published, but no clear consensus on the best technique or device to manage an open abdomen exists. Recent intensive care unit advances, an awareness of intra-abdominal hypertension and abdominal compartment syndrome, and the increased usage of damage control laparotomy have resulted in a new class of challenging patients with open abdominal wounds. Temporary abdominal closure techniques, such as the Bogotá bag or vacuum pack, have been described, along with other closure techniques, including allowing the wound to granulate through a biodegradable mesh and sequential closure using a Vacuum Assisted Closure® device (V.A.C.® Therapy™, KCI, San Antonio, Tex). Each of these methods is reported to reduce complications compared to traditional gauze dressings. The V.A.C.® System allows surgeons to close most open abdomens without the use of skin grafts. Future studies and continued innovation will hopefully lead to better understanding of optimal treatment strategies for these devastating injuries. |
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