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Open Abdomen Complications: Prevention and Management

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Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

The increasing comprehension of the patho-physiology of trauma and Abdominal Compartment Syndrome (ACS) made the Open Abdomen (OA) a cornerstone step of damage control surgery (DCS), but the exposure of the abdominal viscera to the outer environment brings itself a great burden of dreadful complications, the most feared and devastating complication is the formation of an entero-atmospheric fistula (EAF mortality rate that can nowadays still be as high as up to 40%).

Surgical techniques for management of OA have evolved tremendously in the past three decades and currently the use of Negative Pressure Wound Therapy (NPWT) is the best management option. OA complications could be artificially divided in medical and surgical, where medical complications derive from the pathophysiology of a massive open abdominal wound and surgical complications arise from surgical maneuvers performed into the open abdomen.

Prevention is the key point when the use of OA in necessary: the patient should be managed by a multidisciplinary team with a specific expertizes and this team must be aware of the OA associated morbidity. Every attempt should be made to close the abdomen as soon as reasonably possible: a primary fascial closure within the first week of OA seems to be the best way to reduce the complication rate.

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Authors and Affiliations

  1. Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy

    Antonio Tarasconi

  2. Niguarda Hospital Trauma Center, Milan, Italy

    Osvaldo Chiara & Stefania Cimbanassi

  3. Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center – Bologna Local Health District, AUSL, Bologna, Italy

    Arianna Birindelli, Roberto Cirocchi & Gregorio Tugnoli

  4. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Salomone Di Saverio

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Correspondence to Antonio Tarasconi .

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  1. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy

    Federico Coccolini

  2. General Surgery, Virginia Commonvealth University, Richmond, Virginia, USA

    Rao Ivatury

  3. Letterkenny General Hospital, Letterkenny, Donegal, Ireland

    Michael Sugrue

  4. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy

    Luca Ansaloni

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Tarasconi, A. et al. (2018). Open Abdomen Complications: Prevention and Management. In: Coccolini, F., Ivatury, R., Sugrue, M., Ansaloni, L. (eds) Open Abdomen. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-48072-5_17

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