Open Abdomen in Acute Pancreatitis
Leaving the abdomen open can be a prophylactic or therapeutic procedure, and in patients with severe acute pancreatitis, it can be used in potentially two kinds of situations: managing abdominal compartment syndrome and after transabdominal anterior surgical necrosectomy to facilitate drainage. While there is growing support in the literature for the first indication, open abdomen after necrosectomy is not warranted. Abdominal compartment syndrome resistant to nonoperative management including percutaneous drainage of pancreatic ascites usually requires surgical decompression. It should be performed early, and it is an effective way to decrease intra-abdominal pressure. Of the temporary abdominal closure techniques currently available, the mesh-mediated vacuum-assisted closure combining the mechanical traction of a temporary mesh with the negative pressure effect is associated with the highest fascial closure rate and lowest incidence of enteric fistulae.
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