The Open Abdomen: Balancing Pathophysiologic Benefits and Risks in the Era of Improved Resuscitation Practices

  • Derek J. Roberts
  • Jimmy Xiao
  • Andrew W. KirkpatrickEmail author
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


Surgeons leave the abdomen open for anatomical, physiological, and logistical reasons. Physiological derangements after damage control laparotomy are largely related to perfusion/systemic inflammatory disturbances induced by acute bowel injury and intra-abdominal hypertension (IAH). Importantly, both of these derangements are made worse by large-volume crystalloid fluid resuscitation. Potential physiologic benefits of the open abdomen (OA) have long been hypothesized to include prevention or improvement of the adverse effects of abdominal compartment syndrome (ACS). The OA also prevents the more subtle consequences of IAH, facilitates use of active negative pressure peritoneal therapy (which may improve the peritoneal and systemic inflammatory response), allows for delayed reconstructive options when abdominal domain has been lost, and permits planned abdominal re-exploration to remove sponges and reestablish intestinal continuity. However, the survival benefit of damage control (DC) laparotomy has recently been questioned because of the introduction of improved resuscitation practices (such as DC resuscitation and the avoidance of large-volume crystalloid fluid resuscitation) and the risks associated with open abdominal management, including progressive abdominal visceral edema, loss of abdominal domain, massive ventral hernias, enteric leaks, and enteroatmospheric fistulae. As equipoise begins to dwindle regarding the effectiveness and safety of liberal use of damage control laparotomy in the modern era of improved resuscitation practices, randomized evidence is increasingly required to elucidate the situations in which the associated benefits of open abdominal management outweigh the risks.


  1. 1.
    Rezende-Neto J, Rice T, Abreu ES, Rotstein O, Rizoli S. Anatomical, physiological, and logistical indications for the open abdomen: a proposal for a new classification system. World J Emerg Surg. 2016;11:28.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Stelfox HT. Indications for use of damage control surgery and damage control interventions in civilian trauma patients: a scoping review. J Trauma Acute Care Surg. 2015;78:1187–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Brohi K, D’Amours S, Fabian TC, Inaba K, Leppaniemi AK, Moore EE, Navsaria PH, Nicol AJ, Parry N, Stelfox HT. Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study. Annals of surgery. 2016;263(5):1018–27.CrossRefPubMedGoogle Scholar
  4. 4.
    Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Parry N, Nicol AJ, Navsaria PH, Moore EE, Leppaniemi AK, Inaba K, Fabian TC, D’Amours S, Brohi K, Stelfox HT. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg. 2015;79:568–79.CrossRefPubMedGoogle Scholar
  5. 5.
    Roberts DJ, Zygun DA, Faris PD, Ball CG, Kirkpatrick AW, Stelfox HT. Opinions of practicing surgeons on the appropriateness of published indications for use of damage control surgery in trauma patients: an international cross-sectional survey. J Am Coll Surg. 2016;223:515–29.CrossRefPubMedGoogle Scholar
  6. 6.
    Roberts DJ, Zygun DA, Grendar J, Ball CG, Robertson HL, Ouellet JF, Cheatham ML, Kirkpatrick AW. Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review. J Trauma Acute Care Surg. 2012;73:629–39.CrossRefPubMedGoogle Scholar
  7. 7.
    Roberts DJ, Ball CG, Feliciano DV, Moore EE, Ivatury RR, Lucas CE, Fabian TC, Zygun DA, Kirkpatrick AW, Stelfox HT. History of the innovation of damage control for management of trauma patients: 1902–2016. Ann Surg. 2016.Google Scholar
  8. 8.
    Kashuk JL, Moore EE, Millikan JS, Moore JB. Major abdominal vascular trauma–a unified approach. J Trauma. 1982;22:672–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Moore EE. Thomas G. Orr Memorial Lecture. Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg. 1996;172:405–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, Sugrue M, Cheatham M, Ivatury R, Ball CG, Reintam Blaser A, Regli A, Balogh ZJ, D’Amours S, Debergh D, Kaplan M, Kimball E, Olvera C. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome. Curr Opin Crit Care. 2016;22:174–85.PubMedGoogle Scholar
  12. 12.
    Ersryd S, Djavani-Gidlund K, Wanhainen A, Bjorck M. Editor’s choice - abdominal compartment syndrome after surgery for abdominal aortic aneurysm: a nationwide population based study. Eur J Vasc Endovasc Surg. 2016;52:158–65.Google Scholar
  13. 13.
    Roberts DJ, Jenne CN, Ball CG, Tiruta C, Leger C, Xiao Z, Faris PD, McBeth PB, Doig CJ, Skinner CR, Ruddell SG, Kubes P, Kirkpatrick AW. Efficacy and safety of active negative pressure peritoneal therapy for reducing the systemic inflammatory response after damage control laparotomy (the intra-peritoneal vacuum trial): study protocol for a randomized controlled trial. Trials. 2013;14:141.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kirkpatrick AW, Roberts DJ, Faris PD, Ball CG, Kubes P, Tiruta C, Xiao Z, Holodinsky JK, McBeth PB, Doig CJ, Jenne CN. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Miller RS, Morris JA Jr, Diaz JJ Jr, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59:1365–71. discussion 1371–1364CrossRefPubMedGoogle Scholar
  16. 16.
    Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, Bee TK, Fabian TC, Whelan J, Ivatury RR. Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2013;74:113–20. discussion 1120–1122.CrossRefPubMedGoogle Scholar
  17. 17.
    Montalvo JA, Acosta JA, Rodriguez P, Alejandro K, Sarraga A. Surgical complications and causes of death in trauma patients that require temporary abdominal closure. Am Surg. 2005;71:219–24.PubMedGoogle Scholar
  18. 18.
    Schreiber MA. The beginning of the end for damage control surgery. Br J Surg. 2012;99(Suppl 1):10–1.CrossRefPubMedGoogle Scholar
  19. 19.
    Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Holcomb JB, Ware DN, Moore FA. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2002;184:538–43. discussion 543–534.CrossRefPubMedGoogle Scholar
  20. 20.
    Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg. 2003;138:637–42. discussion 642–633.CrossRefPubMedGoogle Scholar
  21. 21.
    Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, Valdivia A, Ware DN, Moore FA. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54:848–59. discussion 859–861.CrossRefPubMedGoogle Scholar
  22. 22.
    Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001;182:542–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Hatch QM, Osterhout LM, Ashraf A, Podbielski J, Kozar RA, Wade CE, Holcomb JB, Cotton BA. Current use of damage-control laparotomy, closure rates, and predictors of early fascial closure at the first take-back. J Trauma. 2011;70:1429–36.CrossRefPubMedGoogle Scholar
  24. 24.
    Johnson JW, Gracias VH, Schwab CW, Reilly PM, Kauder DR, Shapiro MB, Dabrowski GP, Rotondo MF. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma. 2001;51:261–9. discussion 269–271.CrossRefPubMedGoogle Scholar
  25. 25.
    Loftus TJ, Jordan JR, Croft CA, Smith RS, Efron PA, Mohr AM, Moore FA, Brakenridge SC. Temporary abdominal closure for trauma and intra-abdominal sepsis: different patients, different outcomes. J Trauma Acute Care Surg. 2017;82(2):345–50.CrossRefPubMedGoogle Scholar
  26. 26.
    Roberts DJ, Zygun DA, Kirkpatrick AW, Ball CG, Faris PD, Bobrovitz N, Robertson HL, Stelfox HT. A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients. BMJ Open. 2014;4:e005634.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Asensio JA, Petrone P, O’Shanahan G, Kuncir EJ. Managing exsanguination: what we know about damage control/bailout is not enough. Proc (Bayl Univ Med Cent). 2003;16:294–6.CrossRefGoogle Scholar
  28. 28.
    Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL Jr. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476–83. discussion 483–474CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma. 1987;27:1019–24.CrossRefPubMedGoogle Scholar
  30. 30.
    Gregory JS, Flancbaum L, Townsend MC, Cloutier CT, Jonasson O. Incidence and timing of hypothermia in trauma patients undergoing operations. J Trauma. 1991;31:795–8. discussion 798–800CrossRefPubMedGoogle Scholar
  31. 31.
    Kirkpatrick AW, Chun R, Brown R, Simons RK. Hypothermia and the trauma patient. Can J Surg. 1999;42:333–43.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O’Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg. 1997;226:439–47. discussion 447–439CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Weuster M, Bruck A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P, Iden T, Hocker J, Lefering R, Seekamp A, Kluter T. Epidemiology of accidental hypothermia in polytrauma patients: an analysis of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg. 2016;81:905–12.CrossRefPubMedGoogle Scholar
  34. 34.
    Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:S3–11.CrossRefPubMedGoogle Scholar
  35. 35.
    Reed RL 2nd, Johnson TD, Hudson JD, Fischer RP. The disparity between hypothermic coagulopathy and clotting studies. J Trauma. 1992;33:465–70.CrossRefPubMedGoogle Scholar
  36. 36.
    Watts DD, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma. 1998;44:846–54.CrossRefPubMedGoogle Scholar
  37. 37.
    Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30.CrossRefPubMedGoogle Scholar
  38. 38.
    Roberts DJ, De Waele J, Kirkpatrick AW, Malbrain ML. Intra-abdominal hypertension and the abdominal compartment syndrome. In: Gravlee GP, Davis RF, Hammon JW, Kussman BD, editors. Surgical intensive care medicine. 3rd ed. Cham: Springer International Publishing; 2016. p. 621–44.Google Scholar
  39. 39.
    Carr JA. Abdominal compartment syndrome: a decade of progress. J Am Coll Surg. 2013;216:135–46.CrossRefPubMedGoogle Scholar
  40. 40.
    Miller PR, Thompson JT, Faler BJ, Meredith JW, Chang MC. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma. 2002;53:843–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Cotton BA, Reddy N, Hatch QM, LeFebvre E, Wade CE, Kozar RA, Gill BS, Albarado R, McNutt MK, Holcomb JB. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients. Ann Surg. 2011;254:598–605.CrossRefPubMedGoogle Scholar
  42. 42.
    Joseph B, Zangbar B, Pandit V, Vercruysse G, Aziz H, Kulvatunyou N, Wynne J, O’Keeffe T, Tang A, Friese RS, Rhee P. The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg. 2014;76:457–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Malbrain ML, Vidts W, Ravyts M, De Laet I, De Waele J. Acute intestinal distress syndrome: the importance of intra-abdominal pressure. Minerva Anestesiol. 2008;74:657–73.PubMedGoogle Scholar
  44. 44.
    Malbrain ML, De Laet I. It’s all in the gut: introducing the concept of acute bowel injury and acute intestinal distress syndrome. Crit Care Med. 2009;37:365–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Malbrain ML, De Laet I. AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome. Intensive Care Med. 2008;34:1565–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Shah SK, Jimenez F, Letourneau PA, Walker PA, Moore-Olufemi SD, Stewart RH, Laine GA, Cox CS Jr. Strategies for modulating the inflammatory response after decompression from abdominal compartment syndrome. Scand J Trauma Resusc Emerg Med. 2012;20:25.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Xiao Z, Wilson C, Robertson HL, Roberts DJ, Ball CG, Jenne CN, Kirkpatrick AW. Inflammatory mediators in intra-abdominal sepsis or injury - a scoping review. Crit Care. 2015;19:373.Google Scholar
  48. 48.
    Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1997;43:852–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Victoni T, Coelho FR, Soares AL, de Freitas A, Secher T, Guabiraba R, Erard F, de Oliveira-Filho RM, Vargaftig BB, Lauvaux G, Kamal MA, Ryffel B, Moser R, Tavares-de-Lima W. Local and remote tissue injury upon intestinal ischemia and reperfusion depends on the TLR/MyD88 signaling pathway. Med Microbiol Immunol. 2010;199:35–42.CrossRefPubMedGoogle Scholar
  50. 50.
    Biffl WL, Moore EE, Zallen G, Johnson JL, Gabriel J, Offner PJ, Silliman CC. Neutrophils are primed for cytotoxicity and resist apoptosis in injured patients at risk for multiple organ failure. Surgery. 1999;126:198–202.CrossRefPubMedGoogle Scholar
  51. 51.
    Shah SK, Jimenez F, Walker PA, Aroom KR, Xue H, Feeley TD, Uray KS, Norbury KC, Stewart RH, Laine GA, Cox CS Jr. A novel mechanism for neutrophil priming in trauma: potential role of peritoneal fluid. Surgery. 2010;148:263–70.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Kubiak BD, Albert SP, Gatto LA, Snyder KP, Maier KG, Vieau CJ, Roy S, Nieman GF. Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischemia/reperfusion model. Shock. 2010;34:525–34.CrossRefPubMedGoogle Scholar
  53. 53.
    Shah SK, Jimenez F, Walker PA, Xue H, Feeley TD, Uray KS, Norbury KC, Stewart RH, Laine GA, Cox CS Jr. Peritoneal fluid: a potential mechanism of systemic neutrophil priming in experimental intra-abdominal sepsis. Am J Surg. 2012;203:211–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Leng Y, Zhang K, Fan J, Yi M, Ge Q, Chen L, Zhang L, Yao G. Effect of acute, slightly increased intra-abdominal pressure on intestinal permeability and oxidative stress in a rat model. PLoS One. 2014;9:e109350.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Clark JA, Coopersmith CM. Intestinal crosstalk: a new paradigm for understanding the gut as the “motor” of critical illness. Shock. 2007;28:384–93.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Malbrain ML, De Laet I, De Waele JJ, Sugrue M, Schachtrupp A, Duchesne J, Van Ramshorst G, De Keulenaer B, Kirkpatrick AW, Ahmadi-Noorbakhsh S, Mulier J, Pelosi P, Ivatury R, Pracca F, David M, Roberts DJ. The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 2: measurement techniques and management recommendations. Anaesthesiol Intensive Ther. 2014;46:406–32.CrossRefPubMedGoogle Scholar
  57. 57.
    Malbrain ML, Roberts DJ, De Laet I, De Waele JJ, Sugrue M, Schachtrupp A, Duchesne J, Van Ramshorst G, De Keulenaer B, Kirkpatrick AW, Ahmadi-Noorbakhsh S, Mulier J, Ivatury R, Pracca F, Wise R, Pelosi P. The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 1: definitions and pathophysiology. Anaesthesiol Intensive Ther. 2014;46:392–405.CrossRefPubMedGoogle Scholar
  58. 58.
    Cheng J, Wei Z, Liu X, Li X, Yuan Z, Zheng J, Chen X, Xiao G, Li X. The role of intestinal mucosa injury induced by intra-abdominal hypertension in the development of abdominal compartment syndrome and multiple organ dysfunction syndrome. Crit Care. 2013;17:R283.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Timmermans K, Kox M, Scheffer GJ, Pickkers P. Danger in the intensive care unit: damps in critically ill patients. Shock. 2016;45:108–16.CrossRefPubMedGoogle Scholar
  60. 60.
    Marshall JC. Inflammation, coagulopathy, and the pathogenesis of multiple organ dysfunction, syndrome. Crit Care Med. 2001;29:S99–S106.CrossRefPubMedGoogle Scholar
  61. 61.
    Johnson D, Mayers I. Multiple organ dysfunction syndrome: a narrative review. Can J Surg. 2001;48:502–9.Google Scholar
  62. 62.
    Fink MP, Delude RL. Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005;21:177–96.CrossRefPubMedGoogle Scholar
  63. 63.
    Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma. 1998;44:1016–21. discussion 1021–1013CrossRefPubMedGoogle Scholar
  64. 64.
    Balogh ZJ, Lumsdaine W, Moore EE, Moore FA. Postinjury abdominal compartment syndrome: from recognition to prevention. Lancet. 2014;384:1466–75.CrossRefPubMedGoogle Scholar
  65. 65.
    De Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome--a critical analysis. Crit Care. 2006;10:R51.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Cheatham ML, Demetriades D, Fabian TC, Kaplan MJ, Miles WS, Schreiber MA, Holcomb JB, Bochicchio G, Sarani B, Rotondo MF. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Pommerening MJ, DuBose JJ, Zielinski MD, Phelan HA, Scalea TM, Inaba K, Velmahos GC, Whelan JF, Wade CE, Holcomb JB, Cotton BA. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery. 2014;156:431–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Scott BG, Feanny MA, Hirshberg A. Early definitive closure of the open abdomen: a quiet revolution. Scand J Surg. 2005;94:9–14.CrossRefPubMedGoogle Scholar
  69. 69.
    Bjorck M, Kirkpatrick AW, Cheatham M, Kaplan M, Leppaniemi A, De Waele JJ. Amended classification of the open abdomen. Scand J Surg. 2016;105:5–10.CrossRefPubMedGoogle Scholar
  70. 70.
    Bradley MJ, Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, Bee TK, Fabian TC, Whelan JF, Ivatury RR. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST open abdomen registry. JAMA Surg. 2013;148:947–54.CrossRefPubMedGoogle Scholar
  71. 71.
    Campbell A, Chang M, Fabian T, Franz M, Kaplan M, Moore F, Reed RL, Scott B, Silverman R. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75:S1–22.PubMedGoogle Scholar
  72. 72.
    Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238:349–55. discussion 355–347PubMedPubMedCentralGoogle Scholar
  73. 73.
    Bao J, Tan S, Yu W, Lin Z, Dong Y, Chen Q, Shi J, Duan K, Bai X, Xu L, Li J, Li N. The effect of peritoneal air exposure on intestinal mucosal barrier. Gastroenterol Res Pract. 2014;2014:674875.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Tsuei BJ, Magnuson B, Swintosky M, Flynn J, Boulanger BR, Ochoa JB, Kearney PA. Enteral nutrition in patients with an open peritoneal cavity. Nutr Clin Pract. 2003;18:253–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35:127–31.CrossRefPubMedGoogle Scholar
  76. 76.
    Moore SM, Burlew CC. Nutrition support in the open abdomen. Nutr Clin Pract. 2016;31:9–13.CrossRefPubMedGoogle Scholar
  77. 77.
    Rokyta R Jr, Matejovic M, Krouzecky A, Senft V, Trefil L, Novak I. Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status. Intensive Care Med. 2004;30:714–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Derek J. Roberts
    • 1
  • Jimmy Xiao
    • 2
  • Andrew W. Kirkpatrick
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of SurgeryUniversity of Calgary and the Foothills Medical CentreCalgaryCanada
  2. 2.Regional Trauma ProgramUniversity of Calgary and the Foothills Medical CentreCalgaryCanada
  3. 3.Critical Care MedicineUniversity of Calgary and the Foothills Medical CentreCalgaryCanada

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