Advertisement

The Open Abdomen: Management from Initial Laparotomy to Definitive Closure

  • Fred A. Luchette
  • Stathis J. Poulakidas
  • Thomas J. Esposito

Abstract

A 67-year-old patient has undergone a prolonged and complicated operation for mesenteric ischemic (embolic etiology). Circulation has just been restored to the ischemic bowel; however, the patient is hypothermic (34°C), acidotic, and coagulopathic. Which of the following is the appropriate management at this time?
  1. (A)

    Wood’s lamp assessment of bowel viability

     
  2. (B)

    Repeated on-table angiography after 45 minutes

     
  3. (C)

    Administration of mannitol

     
  4. (D)

    Immediate fascial closure of the abdomen

     
  5. (E)

    Creative abdominal closure

     

Keywords

Ventral Hernia Small Intestinal Submucosa Open Abdomen Abdominal Wall Defect Component Separation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lucas CE, Ledgerwood AM. Prospective evaluation of hemostatic techniques for liver injuries. J Trauma 1976; 16:442–451.CrossRefPubMedGoogle Scholar
  2. 2.
    Calne RY, McMaster P, Pentlow BD. The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment. Br J Surg 1979; 66:338–339.CrossRefPubMedGoogle Scholar
  3. 3.
    Feliciano DV, Mattox KL, Jordan GL Jr. Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma 1981; 21:285–290.CrossRefPubMedGoogle Scholar
  4. 4.
    Svodoba JA, Peter ET, Dang DV, et al. Severe liver trauma in the face of coagulopathy: a case for temporary packing and early reexploration. Am J Surg 1982; 144:717–721.CrossRefGoogle Scholar
  5. 5.
    Carmona RC, Peck DZ, Lim RC. The role of packing and planned reoperation in severe hepatic trauma. J Trauma 1984; 24:779–784.CrossRefPubMedGoogle Scholar
  6. 6.
    Rotondo MF, Schwab CW, McGonigal MD, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35:375–383.PubMedGoogle Scholar
  7. 7.
    Wittman DH, Bansal N, Bergstein JM, et al. Staged abdominal repair compares favorably with conventional operative therapy for intra-abdominal infections when adjusting for prognostic factors with a logistic model. Theor Surg [now Eur J Surg] 1994; 25:273.Google Scholar
  8. 8.
    Berger RL, Dunton RF, Leonardi HK, Karlson KJ. Pack and close approach to persistent postcardiopulmonary bypass bleeding. J Am Coll Surg 1994; 178:353–356.PubMedGoogle Scholar
  9. 9.
    Rotondo MR, Zonies DH. The damage control sequence and underlying logic [review]. Surg Clin North Am 1997; 77:761.CrossRefPubMedGoogle Scholar
  10. 10.
    Noetzel W. Die operativer Behandlung der diffusen eitrigen Peritonitis. Verh Dtsch Ges Chir 1908; 34:638.Google Scholar
  11. 11.
    Wittman DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996; 224:10.CrossRefGoogle Scholar
  12. 12.
    Wittman DH, Wallace JR, Schein M. Open abdomen, planned relaparotomy, or staged abdominal repair: is there a difference? World J Surg 1994; 268:S49.Google Scholar
  13. 13.
    Wittman DH, Goris RJA, Ranga bashyam N, et al. Laparostomy, open abdomen, etappenlavage, planned relaparotomy and staged abdominal repair: too many names for a new operative method. In Ruedi TM, ed. State of the Art of Surgery. Reinach, Switzerland: International Society of Surgery, 1994:23.Google Scholar
  14. 14.
    Wittman DH. Staged abdominal repair: development and current practice of an advanced operative technique for diffuse suppurative peritonitis. Acta Chir Austriaca [Eur Surg] 2000; 32:171.Google Scholar
  15. 15.
    Neidehardt JH, Kraft F, Morin A, et al. Le traitement «La ventre ouvert» de certaines peritonites et infections parietals abdmoninales graves: etudes et technique. Chirurgie 1979; 105:272.Google Scholar
  16. 16.
    Maetani S, Tobe T. Open peritoneal drainage as effective treatment of advanced peritonitis. Surgery 1981; 90:804.PubMedGoogle Scholar
  17. 17.
    Porter JM, Ivatury RR, Nassoura ZE. Extending the horizons of “damage control” in unstable trauma patients beyond the abdomen and gastrointestinal tract. J Trauma 1997; 42:559–561.CrossRefPubMedGoogle Scholar
  18. 18.
    Cipolla J, Stawicki SP, Hoff WS, et al. A proposed algorithm for managing the open abdomen. Am Surg 2005; 71:202–207.PubMedGoogle Scholar
  19. 19.
    Myers JA, Latenser BA. Nonoperative progressive “Bogotá bag” closure after abdominal decompression. Am Surg 2002; 68:1029–1030.PubMedGoogle Scholar
  20. 20.
    Feliciano DV, Burch JM. Towel clips, silos, and heroic forms of wound closure. Adv Trauma Crit Care 1991; 6:231–250.Google Scholar
  21. 21.
    Frenandez L, Norwood S, Roettger R, Wilkins HE 3rd.Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40:258–260.CrossRefGoogle Scholar
  22. 22.
    Ghimenton F, Thomson SR, Muckart DJ, Burrows R. Abdominal content containment: practicalities and outcome. Br J Surg 2000; 87:106–109.CrossRefPubMedGoogle Scholar
  23. 23.
    Howdieshell TR, Yeh KA, Hawkins ML, Cue JL. Temporary abdominal wall closure in trauma patients: indications, technique, and results. World J Surg 1995; 19:154–158.CrossRefPubMedGoogle Scholar
  24. 24.
    Howdieshell TR, Proctor CD, Sternberg E, et al. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg 2004; 188:301–306.CrossRefPubMedGoogle Scholar
  25. 25.
    Bender JS, Bailey CE, Saxe JM, et al. The technique of visceral packing: recommended management of difficult fascial closure in trauma patients. J Trauma 1994; 36:182–185.CrossRefPubMedGoogle Scholar
  26. 26.
    Lamb JP, Vitale T, Kaminski DL. Comparative evaluation of synthetic meshes used for abdominal wall replacement. Surgery 1983; 93:643–648.PubMedGoogle Scholar
  27. 27.
    Marmon LM, Vinocur CD, Standiford SB, et al. Evaluation of absorbable polyglycolic acid mesh as a wound support. J Pediatr Surg 1985; 20:737–742.CrossRefPubMedGoogle Scholar
  28. 28.
    Dayton MT, Buchele BA, Shirazi SS, Hunt LB. Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 1986; 121:954–960.PubMedGoogle Scholar
  29. 29.
    Lopez Villata GC, Furio-Bacete V, Ortiz Oshiro E, et al. Experimentally contaminated reabsorbable meshes: their evolution in abdominal wall defects. Int Surg 1995; 80:223–226.Google Scholar
  30. 30.
    Morris JA Jr, Eddy VA, Rutherford EJ. The trauma celiotomy: the evolving concepts of damage control. Curr Probl Surg 1996; 33:609–708.CrossRefGoogle Scholar
  31. 31.
    Bradley SJ, Jurkovich GJ, Pearlman NM, Stiegmann GV. Controlled open drainage of severe intra-abdominal sepsis. Arch Surg 1985; 120:629–631.PubMedGoogle Scholar
  32. 32.
    Heddirch GS, Wexler MJ, McLean AP, Meakins JL. The septic abdomen: open management with Marlex mesh with a zipper. Surgery 1986; 99:399–408.Google Scholar
  33. 33.
    Walsh GL, Chiasson P, Hedderich G, et al. The open abdomen: a Marlex mesh and zipper technique. Surg Clin North Am 1988; 1:25–40.Google Scholar
  34. 34.
    Wittman DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg 1990; 14:218–226.CrossRefGoogle Scholar
  35. 35.
    Aprahamian C, Wittman DH, Bergstein JM, Quebbeman EJ. Temporary abdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma. J Trauma 1990; 30:719–723.PubMedCrossRefGoogle Scholar
  36. 36.
    Wittman DH, Aprahamian C, Bergstein JM, et al. A burrlike device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg 1993; 159:75–79.Google Scholar
  37. 37.
    Barker DE, Kaufman HJ, Smith LA, et al. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma 2000; 48:201–207.CrossRefPubMedGoogle Scholar
  38. 38.
    Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: the vacuum pack. Am Surg 1995; 61:30–35.PubMedGoogle Scholar
  39. 39.
    Smith LA, Barker DE, Chase CW, et al. Vacuum pack technique of temporary abdominal closure: a four year experience. Am Surg 1997; 63:1002–1008.Google Scholar
  40. 40.
    Garner GB, Ware DN, Cocanour CS, et al. Vacuum assisted wound closure provides early fascial reapproximation in trauma patients with open abdomen. Am J Surg 2001; 182:630–638.CrossRefPubMedGoogle Scholar
  41. 41.
    Stone PA, Hass SM, Flaherty SK, et al. Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 2004; 57:1082–1086.CrossRefPubMedGoogle Scholar
  42. 42.
    Hirschberg A, Mattox KL. “Damage control” in trauma surgery. Br J Surg 1993; 80:1501.CrossRefGoogle Scholar
  43. 43.
    Hirschberg A, Mattox KL. Planned reoperation for severe trauma. Ann Surg 1995; 222:3.CrossRefGoogle Scholar
  44. 44.
    Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia: staged management for acute abdominal wall defects. Ann Surg 1994; 219:643.CrossRefPubMedGoogle Scholar
  45. 45.
    Bloomfield G, Saggi B, Blocher C, Sugerman H. Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 1999; 46:1009–1016.CrossRefPubMedGoogle Scholar
  46. 46.
    De Waele JJ, Benoit D, Hoste E, Colardyn F. A role for muscle relaxation in patients with abdominal compartment syndrome. Intensive Care Med 2003; 29:332.PubMedGoogle Scholar
  47. 47.
    Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective review. J Trauma 2000; 49:969–978.CrossRefPubMedGoogle Scholar
  48. 48.
    Dejardin LM, Arnoczky SP, Clarke RB. Use of small intestinal submucosal implants for regeneration of large fascial defects: an experimental study in dogs. J Biomed Mater Res 1999; 46:203–211.CrossRefPubMedGoogle Scholar
  49. 49.
    Badylak S, Kokini K, Tullius B, et al. Morphologic study of small intestinal submucosa as a body wall repair device. J Surg Res 2002; 103:190–202.CrossRefPubMedGoogle Scholar
  50. 50.
    Franklin JJ Jr, Gonzalez ME Jr, Michaelson RP, et al. Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields. Hernia 2002; 6:171–174.CrossRefPubMedGoogle Scholar
  51. 51.
    Menon NG, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 2003; 50:523–527.CrossRefPubMedGoogle Scholar
  52. 52.
    Dalla Vecchia L, Engrum S, Kogon B, et al. Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses. J Pediatr Surg 1999; 34:167–171.CrossRefPubMedGoogle Scholar
  53. 53.
    Cady B, Brooke-Cowden GL. Repair of massive abdominal wall defects: combined use of pneumoperitoneum and Marlex mesh. Surg Clin North Am 1976; 56:559–570.PubMedGoogle Scholar
  54. 54.
    Paletta CE, Huang DB, Dehghan K, Kelly C. The use of tissue expanders in staged abdominal wall reconstruction. Ann Plast Surg 1999; 42:259–265.CrossRefPubMedGoogle Scholar
  55. 55.
    Tran NV, Petty PM, Clay RP, et al. Tissue expansion-assisted closure of massive ventral hernias. J Am Coll Surg 2003; 196:484–488.CrossRefPubMedGoogle Scholar
  56. 56.
    Fansler RF, Taheri P, Cullinane C, et al. Polypropylene mesh closure of the complicated abdominal wound. Am J Surg 1995; 170:15–18.CrossRefPubMedGoogle Scholar
  57. 57.
    Disa JJ, Goldberg NH, Carlton JM, et al. Restoring abdominal wall integrity in contaminated tissue-deficient wounds using autologous fascia grafts. Plast Reconstr Surg 1998; 101:979–986.CrossRefPubMedGoogle Scholar
  58. 58.
    Disa JJ, Chiaramonte MF, Girotta JA, et al. Advantages of autologous fascia versus synthetic patch abdominal reconstruction in experimental animal defects. Plast Reconstr Surg 2001; 108:2086–2087.CrossRefPubMedGoogle Scholar
  59. 59.
    Das SK, Davidson SF, Walker BL, Talbot PJ. The fate of free autogenous fascial grafts in the rabbit. Br J Plast Surg 1990; 43:315–317.CrossRefPubMedGoogle Scholar
  60. 60.
    Feldt-Rasmussen K, Jensen OA. Large ventral herniae treated with free fascial grafts; a follow-up study. Acta Chir Scand 1956; 111:403–408.PubMedGoogle Scholar
  61. 61.
    Girotto JA, Chiaramonte M, Menon NG, et al. Recalcitrant abdominal wall hernias: long-term superiority of autologous tissue repair. Plast Reconstr Surg 2003; 112:106–114.CrossRefPubMedGoogle Scholar
  62. 62.
    Ramirez OM, Uras E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86:519–526.CrossRefPubMedGoogle Scholar
  63. 63.
    Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 2003; 238:349–357.PubMedGoogle Scholar
  64. 64.
    Ennis LS, Young JS, Gampper TJ, Drake DB. The “open book” variation of component separation for repair of massive midline abdominal wall hernia. Am Surg 2003; 69:733–743.PubMedGoogle Scholar
  65. 65.
    de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, et al. “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 2003; 196:32–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Fred A. Luchette
    • 1
  • Stathis J. Poulakidas
    • 1
  • Thomas J. Esposito
    • 2
  1. 1.Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, Loyola University Medical CenterFoster G. McGaw HospitalMaywoodUSA
  2. 2.Department of Surgery, Section of Trauma, Injury Analysis, and Prevention Programs, Loyola University Medical CenterFoster G. McGaw HospitalMaywoodUSA

Personalised recommendations